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Expectant care versus surgical treatment for miscarriage
Kavita Nanda1, Laureen M Lopez, David A Grimes
1Clinical Sciences, FHI, Research Triangle Park, North Carolina, USA. knanda@fhi360.org.
The Cochrane Database of Systematic Reviews
|March 16, 2012
Summary
Expectant management for miscarriage increases risks of incomplete miscarriage and bleeding, but is less costly than surgical treatment. Patient preference is key in choosing between expectant and surgical management for early pregnancy failure.
Area of Science:
- Obstetrics and Gynecology
- Reproductive Health
- Evidence-Based Medicine
Background:
- Miscarriage is a common early pregnancy complication with potential medical and psychological impacts.
- Routine surgical evacuation for miscarriage is debated due to risks like trauma, perforation, hemorrhage, and infection.
Purpose of the Study:
- To compare the safety and effectiveness of expectant management versus surgical treatment for early pregnancy failure.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials.
- Searched multiple databases including Cochrane, PubMed, and POPLINE.
- Included seven trials with 1521 participants comparing expectant care with surgical treatment (vacuum aspiration or D&C).
Main Results:
- Expectant management resulted in higher rates of incomplete miscarriage (up to 28% vs 4%) and increased need for unplanned surgery.
- Expectant management was associated with more bleeding days and a higher need for blood transfusions.
- Infection and psychological outcomes were similar; expectant management was significantly less costly.
Conclusions:
- Expectant management increases risks of incomplete miscarriage, unplanned surgery, bleeding, and transfusion compared to surgical treatment.
- Infection and psychological outcomes were comparable between the two management approaches.
- Lower costs favor expectant management, but patient preference is crucial for decision-making in early pregnancy failure management.
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