A RANDOMIZED COMPARATIVE STUDY OF EXPECTANT, MEDICAL AND SURGICAL MANAGEMENT OF FIRST TRIMESTER MISCARRIAGE

Abstract

Introduction: Diagnosis of miscarriage has traditionally been followed by suction & evacuation of retained products of conception, on the assumption that this decreases the risk of subsequent gynecological infection. However, surgical management is not without its complications i.e. infection, uterine perforation or bowel damage.

Aim and Objective: To assess the outcome of suction and evacuation (expectant or medical) management of first trimester miscarriage for a finite period of 14 days.

Material and Methods: The present study is a randomized, prospective observational study which evaluated surgical and non surgical (expectant and medical) management of first trimester (<12 weeks of gestation) miscarriage based on the last menstrual period. A total of 141 women were included. Results: Incidence of first trimester miscarriage of <12 weeks of gestation was 23.5% in symptomatic/asymptomatic women and out of which 90.78% of patients were symptomatic. Mean age of women was 25.64±4.63, 26.64±4.73, 26.98±4.79 years, mean number of previous abortion was 0.58±0.67, 0.69±0.83, 0.84±0.89 for expectant, medical and surgical category. respectively. Mean gestation age was 9 weeks, 9 weeks + 3 days, 9 weeks + 2 days for expectant, medical and surgical management respectively. 91.48% women in the study were of 7-12 weeks of gestation. Mean AP diameter between two endometrial myometrial junction was 20.21±11.69 mm, 17.50±13.39 mm and 23.94±9.99 mm, overall success rate 66.66%, 82.22% and 96.67% for expectant, medical and surgical management respectively. 8.95% complication rate for non surgical (expectant and medical category), 3.33%, 21.62% and 6.12% respectively for expectant, medical and surgical management found. Successful outcome without complication were 64.44%, 71.11% and 90.20% in expectant, medical and surgical management respectively. Mean bleeding per vaginum days for expectant, medical and surgical management were 14.03±4.79, 9.45±3.34 and 5.24±4.38 days.

Conclusion: Suction and evacuation is a safe and effective method for management for first trimester miscarriage and women can only be offered with surgical management if emergency evacuation is affordable and available. Single dose of 600µg misoprostol decreased the duration of bleeding per vaginum and increased the success rate as compared to expectant management.