title: Expectant Versus Surgical Management of Early Pregnancy Miscarriages- A Prospective Study.
abstract: BACKGROUND
  Surgical, medical and expectant management are the various options available to manage early pregnancy miscarriages; each with its own merits and demerits. In the last two decades, the efficacy and safety of expectant management which allows for the spontaneous passage of retained products of conception has been studied and confirmed.
  
  
  OBJECTIVE
  To compare the safety and efficacy of expectant management of early pregnancy miscarriages with surgical uterine evacuation.
  
  
  METHODS
  The prospective study conducted in tertiary care centre for 5 years, included 212 patients with USG confirmed pregnancy miscarriages of less than 13 weeks, who were allocated to expectant management (Cases, n=112) and surgical evacuation (Control, n=100). Patients were allocated for expectant management as outpatients for 2 weeks, without any intervention till they had spontaneous complete miscarriage which was confirmed by sonography. Those who failed to do so, underwent a planned surgical uterine evacuation. Emergency admission and evacuation was done, if the patients became symptomatic in the waiting period. Patients allocated to surgical group underwent planned surgical evacuation once diagnosed. Success rate and complications like emergency evacuation, vaginal bleeding, abdominal pain, limitation of physical activity and patient satisfaction were assessed. Both groups were followed up for 6 more weeks. Statistical analysis was done with Z-test.
  
  
  RESULTS
  Success rate of the expectant management was 71% as against 97% in surgical group. Severe vaginal bleeding was comparable (5% in both groups), 8% of expectant had severe abdominal pain versus 4% in surgical group. Unplanned admissions and emergency evacuation rate was high in expectant 9% against 1% in surgical group. Twenty one percent patients in expectant and 17% patients in surgical group experienced limitation of physical activity. Overall patient satisfaction rate was comparable (74% in expectant 80% in surgical group).
  
  
  CONCLUSIONS
  Expectant management of miscarriages has a success rate of 71%. Compared to surgical management, abdominal pain, unplanned admissions, emergency evacuation and limitation of physical activity were more in expectant group. Success rate can be improved and complications can be minimised with proper patient selection and counseling.
authors.affiliation: Associate Professor, Department of Obstetrics and Gynaecology, Government Medical College , Palakkad, Kerala, India .
authors.forename: Reshma
authors.initials: R
authors.lastname: Sajan
authors.affiliation: Associate Professor, Department of Obstetrics and Gynaecology, MES Medical College , Perinthalmanna Kerala, India .
authors.forename: Mumtaz
authors.initials: M
authors.lastname: Pulikkathodi
authors.affiliation: Professor, Department of Obstetrics and Gynaecology, MES Medical College , Perinthalmanna, Kerala, India .
authors.forename: Abdul
authors.initials: A
authors.lastname: Vahab
authors.affiliation: Professor, Department of Obstetrics and Gynaecology, KMCT Medical College , Calicut, Kerala, India .
authors.forename: Valsan Mankara
authors.initials: VM
authors.lastname: Kunjitty
authors.affiliation: Senior Resident, Department of Obstetrics and Gynaecology, MES Medical College , Perinthalmanna, Kerala, India .
authors.forename: Hassan Sheikh
authors.initials: HS
authors.lastname: Imrana
keywords: Anembryonic pregnancy; Early fetal demise; Expectant management; Incomplete miscarriage