Management of spontaneous miscarriage in the first trimester: an example of putting informed shared decision making into practice.
TL;DR: Surgical evacuation is unnecessary after a complete miscarriage with retained products of conception and should be indicated by clinical rather than ultrasonographical criteria and medical management has no apparent benefits.
read more
Abstract: Editorial by Cahill
In many parts of the Western world there is a strong preference among gynaecologists to rely on surgical evacuation for the management of miscarriages in the first trimester Why so many specialists have adopted surgery as the standard procedure seems determined by custom and habit and rooted in history rather than being an evidence based choice During the first half of the 20th century the high rate of infections from retained products of conception with ensuing mortality from septicaemia—often complications from criminal attempts to terminate a pregnancy—resulted in the policy of immediate surgical evacuation whenever a diagnosis of inevitable abortion was made1 Today these complications are rare, and their role in the justification of a universal tendency to perform surgery has therefore expired2
Expectant management finds its main protagonists in general practice, where the process of spontaneous miscarriage is acknowledged more readily as being a well regulated natural process in human reproduction
Relatively new is the medical approach to spontaneous miscarriages3 The combination of the antiprogestogen mifepristone and the prostaglandin analogue misoprostol is being used successfully for the termination of pregnancies on a large scale The use of these substances has also been tried in the management of spontaneous miscarriage
Doctors and patients are confronted with a situation where opinions about the proper management of spontaneous miscarriage differ widely That the available options are so diverse makes it even more complex This paper aims to increase the awareness of various management options and explores the available evidence
#### Summary points
Surgical evacuation is unnecessary after a complete miscarriage with retained products of conception and should be indicated by clinical rather than ultrasonographical criteria
Expectant management is used in general practice on a large scale and is more feasible than surgical evacuation
Medical management has no apparent benefits …
read more
Chat with Paper
AI Agents for this Paper
Find similar papers on Google Scholar, PubMed and Arxiv
Write a critical review of this paper
Analyze citations of this paper to find unaddressed research gaps
Citations
•Journal Article
Management of spontaneous abortion.
TL;DR: Physicians should be aware of psychologic issues that patients and their partners face after completing a spontaneous abortion, and are at increased risk for significant depression and anxiety for up to one year after spontaneous abortion.
269
Misoprostol versus curettage in women with early pregnancy failure after initial expectant management: A randomized trial
TL;DR: Curettage is superior to misoprostol in the evacuation of early pregnancy failure after failed expectant management and could be clinically useful since it reduces the need for curettage by half and has a lower complication rate, at the expense of increased pain, vaginal bleeding and emergency evacuation.
85
A randomized prospective study of misoprostol or mifepristone followed by misoprostol when needed for the treatment of women with early pregnancy failure.
David Stockheim,Ronit Machtinger,Amir Wiser,Mordechai Dulitzky,David Soriano,Mordechai Goldenberg,Eyal Schiff,Daniel S. Seidman +7 more
TL;DR: Misoprostol is an effective and safe treatment for early pregnancy failure and could replace surgical curettage in over two-thirds of the patients and Mifepristone offers no advantage compared with misoprostols as initial treatment.
66
Women's preferences for attributes of first-trimester miscarriage management: a stated preference discrete-choice experiment.
Stavros Petrou,Emma McIntosh +1 more
TL;DR: The preference results generated by this study suggest that many women undergoing management of first-trimester miscarriage would value being offered alternatives to expectant management.
59
References
Paternalism or partnership?: Patients have grown up—and there's no going back
TL;DR: The articles assembled in this issue of the BMJ consider the scope for creating meaningful partnerships between doctors and patients and between health policymakers and local communities.
What do we mean by partnership in making decisions about treatment
TL;DR: The call for doctor-patient partnerships opens up options beyond paternalism for approaching the task of making decisions about treatment, but it also raises new complexities.
691
Why Mothers Die — Report on Confidential Enquiries into Maternal Deaths in the United Kingdom 1994–96
J. A. Crowhurst,F. Plaat +1 more
TL;DR: This is the fifteenth Report in this series on maternal deaths and is the fourth reporting on deaths in the UK as a whole, with an increase in the absolute numbers of Direct and Indirect deaths in this triennium.
371
Medical management of missed abortion and anembryonic pregnancy.
TL;DR: Mifepristone and misoprostol were administered to 60 women diagnosed with missed abortion or anembryonic pregnancy equivalent to 13 weeks' gestation or less who were recruited after counselling.
110
Re: Medical management of miscarriage
TL;DR: Medical management of miscarriage using a suitable prostaglandin analogue is a safe and effective alternative with high efficacy and patient acceptability and can be routinely offered as an alternative option, thereby increasing women's choice.
27