[Treatment options for early miscarriage; new insights]

Area of Science:

• Obstetrics and Gynecology
• Reproductive Health
• Clinical Decision Making

Background:

• Miscarriage is a frequent first-trimester pregnancy complication.
• Available treatments include expectant management, curettage, and medical management with misoprostol.
• Curettage, while traditional, carries risks like surgical complications and Asherman syndrome.

Purpose of the Study:

• To compare the cost-effectiveness and safety of early miscarriage treatments.
• To highlight the importance of patient preference and shared decision-making in treatment selection.
• To identify the need for multidisciplinary guidelines in the Netherlands for miscarriage management.

Main Methods:

• Comparative analysis of treatment options for early miscarriage.
• Review of existing literature on miscarriage management, cost-effectiveness, and complications.
• Emphasis on shared decision-making principles in clinical practice.

Main Results:

• Expectant management and medical management with misoprostol are more cost-effective than curettage.
• Curettage is associated with increased risks of surgical complications, Asherman syndrome, and preterm birth.
• Patient preference is a key factor in choosing the optimal treatment strategy.

Conclusions:

• Medical and expectant management offer safer and more cost-effective alternatives to curettage for early miscarriage.
• Shared decision-making is crucial for aligning treatment with patient preferences and values.
• Developing multidisciplinary guidelines is essential for standardized and improved miscarriage care in the Netherlands.