Expectant management of first-trimester miscarriage in clinical practice.
BACKGROUND
The aim of this study was to evaluate treatment efficacy and patient compliance in women with an early miscarriage managed expectantly in routine clinical practice.


METHODS
During 1995-98, 263 consecutive women who sought medical attention for an ongoing or incomplete miscarriage (gestational length <99 days), and who were circulatory stable and had a gestational residue measuring 15-50 mm (anterio-posterior, A-P diameter) on ultrasound examination were invited to participate in this study. Hemoglobin (Hb), C-reactive protein (CRP), human chorionic gonadotrophin (hCG), progesterone and Rh-factor were analyzed and a questionnaire regarding the pregnancy, duration of genital bleeding and number of days of absenteeism was completed on admission and after 1 and 4 weeks.


RESULTS
Expectant management was considered to be complete (vaginal ultrasound, gestational residue <15 mm after 1 week) in 83%. The patients who were managed successfully by expectant management had a smaller gestational residue (p = 0.026) and a lower mean serum progesterone level (p = 0.025) on referral than in the group of women with failed expectant management. A gynecologic infection was diagnosed in seven cases (3%) and five of the infections were in the group of women who underwent dilatation and curettage. No patient required a blood transfusion. The mean number of days of absenteeism was 3.2 days. There were no differences in Hb levels before or after treatment, number of bleeding days or absenteeism between the groups.


CONCLUSIONS
Expectant management of clinically stable patients with symptoms of early miscarriage is safe, efficient and well tolerated.
Blohm
Febe
F
Departments of Obstetrics and Gynecology, Sahlgrenska University Hospital/East, SE-416 85 Gothenburg, Sweden. febe.blohm@vgregion.se
Fridén
Barbro
B
Platz-Christensen
Jens-Jörgen
JJ
Milsom
Ian
I
Nielsen
Sven
S
D000027:Abortion, Incomplete / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D003061:Codeine / Q000627:therapeutic use; D004107:Dilatation and Curettage; D005260:Female; D006785:Hospitals, University; D006801:Humans; D009664:Norway; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D017699:Pelvic Pain / Q000188:drug therapy; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D012075:Remission, Spontaneous; D011795:Surveys and Questionnaires; D014463:Ultrasonography
D000082:Acetaminophen; D003061:Codeine