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Abstract

Management of spontaneous miscarriages in the first trimester: Expectant care versus surgical treatment

This study of patients with first trimester miscarriage evaluates if conservative management is a feasible strategy and assesses the value of colour Doppler ultrasonography for patients? selection. After confirmation of the diagnosis by transvaginal sonography all patients were offered the choice of immediate dilatation and curettage or conservative management.

The presence of a gestational sac, the occurrence of spontaneous complete miscarriage within 28 days, detectable pulsatile blood flow within the placenta in the presumed region of the intervillous space and post treatment complications were the main end-points. A total of 108 women were recruited; 23 (21.3%) elected to undergo immediate dilatation and curettage and 85 (78.7%) chose conservative management. The treatment groups were similar in age, gestational age, gestational sac diameter, serum hCG and progesterone levels, and in the proportion of patients who had post treatment complications (12 to 13%). 71/85 (84%) patients in the conservative management group had a spontaneous, complete abortion. 37/46 (80%) of cases with detectable presumed intervillous pulsatile blood flow had a complete, spontaneous abortion within one week, whereas this occurred in 23% of cases with absent flow. This suggests that conservative management is a successful approach for many patients with first-trimester miscarriage; colour Doppler ultrasonography can be used to select the most suitable patients for this strategy, and thus reduce the need for hospital admission and surgery.

CME Prakt Fortbild Gynakol Geburtsmed Gynakol Endokrinol 2016; 12(3): 246–260

Keywords
Spontaneous first trimester miscarriage, expectant management, D&C, Hospital Anxiety and Depression Scale (HADS)

Tamina Rawnaq, Moritz Döbert, Peter Schwärzler
Frauenklinik der Asklepios Klinik Barmbek, Hamburg
Reviewer: Ulrike Friebe-Hoffmann, Ulm,
und Sybille Schmidt, Düsseldorf

Rawnaq T. Operatives ... Gynakol Geburtsmed Gynakol Endokrinol 2016; 12(3): 246–260 publiziert 30.11.2016 www.akademos.de/gyn ©akademos Wissenschaftsverlag 2016 ISSN 1614-8533