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Early pregnancy failure--current management concepts.

M D Creinin1, J L Schwartz, R S Guido

  • 1Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Women's Hospital, Pennsylvania 15213-3180, USA.

Obstetrical & Gynecological Survey
|February 24, 2001
PubMed
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Early pregnancy failure management options are evolving beyond traditional D&C. Expectant management may pose risks, while medical management with misoprostol shows promise but requires more research.

Area of Science:

  • Obstetrics and Gynecology
  • Reproductive Medicine

Background:

  • Miscarriage affects approximately 25% of women.
  • Dilatation and curettage (D&C) has been the standard for over 50 years.
  • D&C is typically performed in an operating room, increasing costs.

Purpose of the Study:

  • To review current management options for early pregnancy failure.
  • To evaluate the efficacy and safety of expectant management, outpatient D&C, and medical management with misoprostol.
  • To highlight the need for more large-scale studies on treatment efficacy and patient preferences.

Main Methods:

  • Literature review of studies on early pregnancy failure management.
  • Analysis of data regarding expectant management, D&C (including manual vacuum aspiration), and misoprostol treatment.

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  • Assessment of complication rates, efficacy, and patient acceptability.

    • Main Results:

    • Expectant management may lead to complications if not properly managed.
    • Outpatient D&C using manual vacuum aspiration is a safe alternative.
    • Vaginal misoprostol demonstrates high expulsion rates (80-90%) up to 13 weeks gestation, but data is limited.

    Conclusions:

    • There is a lack of comprehensive data on the relative efficacy, side effects, and acceptability of different management options.
    • Further large-scale studies are needed to guide clinical decision-making for early pregnancy failure.
    • Women generally prefer active management strategies.