Expectant management of first-trimester spontaneous abortion

doi:10.1016/S0140-6736(95)90060-8

The Lancet

Volume 345, Issue 8942, 14 January 1995, Pages 84-85

https://doi.org/10.1016/S0140-6736(95)90060-8 Get rights and content

Abstract

Approximately 15% of registered pregnancies end in spontaneous abortion, and for 50 years or so dilatation and curettage (D&C) has been the usual management. In a prospective randomised trial we compared the clinical results after either expectant management or D&C, for miscarriages of less than 13 weeks' gestation in which transvaginal ultrasound examination showed intrauterine tissue and/or blood clots with a diameter 15-50 mm. 103 patients were randomised to expectant management and spontaneous resolution of pregnancy occurred within 3 days in 81 cases (79%). 52 patients were randomised to D&C. 3 infections were diagnosed among patients who underwent expectant management (3%); 5 infections and 1 case of postoperative anaemia were observed among patients randomised to D&C (11%). The duration of vaginal bleeding was a mean of 1·3 days longer in the expectant management group (p<0·02). Convalesence time, time during which patients experienced pain, and packed-cell volume 3 and 14 days after inclusion did not differ significantly between the groups. This study shows that expectant management of selected cases of spontaneous abortion has a similar outcome to D&C.

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To compare the efficacy of priming the uterine cervix before Manual Vaccum Aspiration (MVA) using 200 µg or 400 µg of vaginal misoprostol, inserted a mean time of 6 h before MVA in first trimester miscarriage.
Randomized, triple-blind, non-inferiority clinical trial. Patients between 18 and 50 years old, with a diagnosis of miscarriage, were eligible for the study. Patients were allocated to receive either 200 μg or 400 µg of misoprostol before the MVA. The primary outcome was the need to dilate the uterine cervix with mechanical dilators (Hegar dilators). As a secondary outcome, cervical dilatation ≥8 mm before the procedure was considered successful. A difference of <25% was considered as non-inferior.
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2014, Journal de Gynecologie Obstetrique et Biologie de la Reproduction
L’objectif de ce travail est d’évaluer la relation entre psychologie et perte de grossesse.
Une revue de la littérature a été effectuée en consultant les données Medline jusqu’en avril 2014.
Les facteurs psychologiques semblent significativement associés au risque de récidive d’une fausse couche (FC). La dépression et l’anxiété sont des symptômes fréquents après une FC. Un retour à la normale des scores de dépression et d’anxiété est fréquemment retrouvé à un an. Une prise en charge psychologique systématique après un épisode de FC ne semble pas apporter un bénéfice évident à un an de la FC, en termes d’anxiété et de dépression. Après une mort fœtale in utero (MFIU), des répercussions psychologiques sur le couple à type d’anxiété et de symptômes dépressifs sont fréquentes. Une attitude empathique et respectueuse de l’ensemble de l’équipe médicale et paramédicale lors de la prise en charge est associée à un meilleur vécu psychologique.
Après une perte de grossesse, les répercussions psychologiques sont fréquentes et le plus souvent réversibles. Une attitude d’empathie est souhaitable pour accompagner les patientes et envisager une future grossesse.
The objective of this study was to evaluate the relationship between psychology and pregnancy loss.
A literature review was conducted by consulting Medline until April 2014.
Psychological factors appear to be significantly associated with the risk of recurrent miscarriage. Depression and anxiety are common symptoms after miscarriage. A return to normal scores of depression and anxiety is frequently found in one year. A systematic psychological treatment after an episode of miscarriage seems to not bring obvious benefits, one year after a miscarriage, in terms of anxiety and depression. After a stillbirth, psychological impacts on the couple, such as anxiety and depressive symptoms, are common. An empathetic and respectful attitude of all medical and paramedical team at the support is associated with better psychological experience.
After a pregnancy loss, psychological consequences are common and usually reversible. An attitude of empathy is desirable in order to accompany patients and to consider a future pregnancy.
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Citation Excerpt :
However, the study performed by Ben-Baruch et al. [30] had small numbers (35 patients) and the report of Kaplan et al. [31] was based on an observational study (161 patients). The reported incidence of gynaecological infection was higher among women managed surgically (0–10%) than managed conservatively (0–3%) [1,3,7–11]. In our own trial, the risk of endometritis in both groups was very low (4% in the surgical group and 3% in women managed expectantly) which was comparable and similar to the MIST trial [32].
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