title: Clinical and psychological impact after surgical, medical or expectant management of first-trimester miscarriage--a randomised controlled trial.
abstract: BACKGROUND
  The management of first-trimester miscarriage has been studied extensively in recent years. However, relatively little attention has been focussed on woman's satisfaction and psychological impact from different treatment modalities.
  
  
  OBJECTIVE
  To investigate the clinical and psychological outcomes of surgical, medical and expectant management of first-trimester miscarriage.
  
  
  METHODS
  A prospective randomised controlled trial of 180 women suffering miscarriage managed by either surgical evacuation, medical evacuation or expectant management was conducted in a university-affiliated, tertiary referral hospital. The complete miscarriage rate, clinical symptomatology, complications, women's satisfaction and the psychological impact were evaluated.
  
  
  RESULTS
  Women in surgical evacuation (98.1%) had a significantly higher complete miscarriage rate when compared with medical evacuation (70%) and expectant management (79.3%). Women who had surgical evacuation had significantly shorter duration of vaginal bleeding, but higher rate of infection. Women who had medical evacuation had significantly more gastrointestinal symptoms. Despite differences in efficacy and complication profile, there was no significant difference in satisfaction among groups. There were no significant differences in terms of psychological well-being, depression scores, anxiety level, fatigue symptoms as measured in General Health Questionnaire-12, Beck Depression Inventory, Spielberger's State Anxiety Inventory and fatigue scale at treatment and four weeks after treatment. However, women with active intervention had greater post-traumatic stress symptoms as measured in Chinese version of Impact of Event Scale-Revised at the time of treatment when compared with women in expectant management.
  
  
  CONCLUSIONS
  Without substantial differences in the clinical and psychological impact between different treatment modalities, a more conservative approach with expectant management for miscarriage may be an option for women.
authors.affiliation: Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China. gracekong@cuhk.edu.hk
authors.forename: Grace Wing Shan
authors.initials: GW
authors.lastname: Kong
authors.forename: Ingrid Hung
authors.initials: IH
authors.lastname: Lok
authors.forename: Alice Ka Wah
authors.initials: AK
authors.lastname: Yiu
authors.forename: Annie Shuk Yi
authors.initials: AS
authors.lastname: Hui
authors.forename: Beatrice Pui Yee
authors.initials: BP
authors.lastname: Lai
authors.forename: Tony Kwok Hung
authors.initials: TK
authors.lastname: Chung
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000009:adverse effects; D000027:Abortion, Incomplete / Q000209:etiology; D000022:Abortion, Spontaneous / Q000523:psychology* / Q000628:therapy*; D000328:Adult; D004107:Dilatation and Curettage / Q000009:adverse effects / Q000523:psychology; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000009:adverse effects; D017060:Patient Satisfaction; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology; D011795:Surveys and Questionnaires; D014592:Uterine Hemorrhage / Q000209:etiology; D057832:Watchful Waiting
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol