title: A randomised controlled trial of expectant management versus surgical evacuation of early pregnancy loss.
abstract: OBJECTIVE
  To show whether a clinically significant difference in success rates exists between expectant and surgical management of early pregnancy loss.
  
  
  METHODS
  Randomised controlled trial comparing expectant versus surgical management of early pregnancy loss over a 1-year period from 1st January to 31st December 2009 at Sultanah Aminah Hospital, Johor Bahru. Pregnant women with missed or incomplete miscarriages at gestations up to 14 weeks were recruited in this study. The success rate in the surgical group was measured as curettage performed without any complications during or after the procedure, while the success rate in the expectant group was defined as complete spontaneous expulsion of products of conception within 6 weeks without any complication.
  
  
  RESULTS
  A total of 360 women were recruited and randomised to expectant or surgical management, with 180 women in each group. There was no statistically significant difference in the success rate between the groups and between the different types of miscarriage. With expectant management, 131 (74%) patients had a complete spontaneous expulsion of products of conception, of whom 106 (83%) women miscarried within 7 days. However, the rates of unplanned admissions (18.1%) and unplanned surgical evacuations (17.5%) in the expectant group were significantly higher than the rates (7.4% and 8% respectively) in the surgical group. The complications in both groups were similar.
authors.affiliation: Department of Obstetrics and Gynaecology, Sultanah Aminah Hospital, 80100 Johor Bahru, Malaysia(1). Electronic address: ratadran@yahoo.com.
authors.forename: Ravichandran
authors.initials: R
authors.lastname: Nadarajah
authors.affiliation: Department of Obstetrics and Gynaecology, Sultanah Aminah Hospital, 80100 Johor Bahru, Malaysia(1).
authors.forename: Yek Song
authors.initials: YS
authors.lastname: Quek
authors.affiliation: Department of Obstetrics and Gynaecology, Sultanah Aminah Hospital, 80100 Johor Bahru, Malaysia(1).
authors.forename: Kaliammah
authors.initials: K
authors.lastname: Kuppannan
authors.affiliation: Department of Obstetrics and Gynaecology, Sultanah Aminah Hospital, 80100 Johor Bahru, Malaysia(1).
authors.forename: Shu Yuan
authors.initials: SY
authors.lastname: Woon
authors.affiliation: Department of Obstetrics and Gynaecology, Sultanah Aminah Hospital, 80100 Johor Bahru, Malaysia(1).
authors.forename: Ravichandran
authors.initials: R
authors.lastname: Jeganathan
mesh_terms: D000027:Abortion, Incomplete / Q000000981:diagnostic imaging / Q000601:surgery*; D000022:Abortion, Spontaneous / Q000000981:diagnostic imaging; D000328:Adult; D004107:Dilatation and Curettage; D005260:Female; D006801:Humans; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D016896:Treatment Outcome; D014463:Ultrasonography; D057832:Watchful Waiting
keywords: Early pregnancy loss; Expectant; Incomplete miscarriage; Missed miscarriage; Surgical evacuation