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Expectant care versus surgical treatment for miscarriage.
K Nanda1, A Peloggia, D Grimes
1Family Health International, Clinical Research Department, PO Box 13950, Research Triangle Park, NC 27709, USA. knanda@fhi.org
The Cochrane Database of Systematic Reviews
|April 21, 2006
Summary
Expectant management for miscarriage increases risks of incomplete abortion and bleeding, while surgical treatment raises infection rates. Woman's preference is key in choosing between expectant management and surgical evacuation for early pregnancy loss.
Area of Science:
- Obstetrics and Gynecology
- Reproductive Health
Background:
- Miscarriage is a common early pregnancy complication with potential medical and psychological effects.
- Routine surgical evacuation for miscarriage is debated due to risks like cervical trauma and infection.
Purpose of the Study:
- To compare the safety and effectiveness of expectant management versus surgical treatment for early pregnancy loss.
Main Methods:
- Searched multiple databases including Cochrane, PubMed, POPLINE, and LILACS up to March 2005.
- Included randomized trials comparing expectant care with surgical treatment (vacuum aspiration or D&C) for miscarriage.
- Two authors independently assessed trial quality and extracted data.
Main Results:
- Expectant management increased the likelihood of incomplete miscarriage (RR 5.37) and need for unplanned surgery (RR 4.78).
- Expectant management also led to more days of bleeding and a greater amount of bleeding.
- Surgical evacuation was associated with a higher risk of post-procedure infection (RR 0.29 for expectant care).
Conclusions:
- Expectant management has higher risks of incomplete miscarriage, need for surgery, and bleeding, though not serious.
- Surgical evacuation carries a significantly higher risk of infection.
- Given comparable outcomes, patient preference should guide the choice between expectant management and surgical evacuation.