title: The impact of introducing medical management on conservative and surgical management for early pregnancy miscarriage.
abstract: BACKGROUND
  Medical management of miscarriage allows women to avoid the risks associated with surgical intervention. In 2011 the early pregnancy assessment service (EPAS) at the Royal Prince Alfred Hospital (RPAH) in Sydney, Australia introduced medical management of miscarriage with single-dose 800 μg vaginal misoprostol.
  
  
  OBJECTIVE
  We sought to investigate the impact of the introduction of medical management had on the proportion of women having surgery and conservative management and to examine the success and complication rates of medical management.
  
  
  METHODS
  We undertook a retrospective cohort study that included all women diagnosed with a miscarriage from 12 months prior to and 18 months after the introduction of medical management. Successful management was defined as the absence of retained products of conception or endometrial thickness less than 15 mm on ultrasound at two weeks. The change in management choices over time, the success rates and complication rates were measured.
  
  
  RESULTS
  Of 1102 women in the final analysis, 446 were in Group A (before medical management) and 656 in Group B (after medical management). Primary surgical procedures fell significantly for missed miscarriages from 68 to 48% (P < 0.001) and primary conservative management reduced for incomplete miscarriages (63-44%; P = 0.01). Overall 89 of 108 (82.4%) patients managed medically had a resolution within two weeks. One in ten presented with a complication.
  
  
  CONCLUSIONS
  The introduction of medical management led to a statistically significant reduction in the proportion of women undergoing primary surgical management of missed miscarriage. Success and complication rates were similar to other studies.
authors.affiliation: Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.|Women's and Babies, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors.forename: Kirsten I
authors.initials: KI
authors.lastname: Black
authors.affiliation: Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.|Women's and Babies, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors.forename: Bradley S
authors.initials: BS
authors.lastname: de Vries
authors.affiliation: Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Francis
authors.initials: F
authors.lastname: Moses
authors.affiliation: Women's and Babies, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors.forename: Marilena
authors.initials: M
authors.lastname: Pelosi
authors.affiliation: Women's and Babies, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors.forename: Angela
authors.initials: A
authors.lastname: Cong
authors.affiliation: Women's and Babies, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
authors.forename: Joanne
authors.initials: J
authors.lastname: Ludlow
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D000027:Abortion, Incomplete / Q000628:therapy*; D000030:Abortion, Missed / Q000628:therapy*; D000282:Administration, Intravaginal; D000328:Adult; D000072700:Conservative Treatment / Q000706:statistics & numerical data* / Q000639:trends; D004107:Dilatation and Curettage / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D005865:Gestational Age; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage / Q000627:therapeutic use*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
keywords: dilatation and curettage; early pregnancy complication; miscarriage; misoprostol