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Outcome of expectant management of spontaneous first trimester miscarriage: observational study

Luise, Ciro ; Jermy, Karen ; May, Caroline ; Costello, Gillian ; Collins, William P ; Bourne, Thomas H

BMJ, 2002-04, Vol.324 (7342), p.873-875 [Periódico revisado por pares]

London: British Medical Journal Publishing Group

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  • Título:
    Outcome of expectant management of spontaneous first trimester miscarriage: observational study
  • Autor: Luise, Ciro ; Jermy, Karen ; May, Caroline ; Costello, Gillian ; Collins, William P ; Bourne, Thomas H
  • Assuntos: Abortion, Incomplete - surgery ; Abortion, Incomplete - therapy ; Adult ; Biological and medical sciences ; Bleeding ; Diseases of mother, fetus and pregnancy ; Female ; First trimester of pregnancy ; Gynecology ; Gynecology. Andrology. Obstetrics ; Health care ; Health care outcome assessment ; Humans ; Infections ; Medical research ; Medical sciences ; Miscarriage ; Observational studies ; Pregnancy ; Pregnancy complications ; Pregnancy Trimester, First ; Pregnancy. Fetus. Placenta ; Remission, Spontaneous ; Time Factors ; Ultrasonography
  • É parte de: BMJ, 2002-04, Vol.324 (7342), p.873-875
  • Notas: ArticleID:bmj.324.7342.873
    ark:/67375/NVC-MPWPF7BT-Z
    local:bmj;324/7342/873
    Correspondence to: T Bourne
    href:bmj-324-873.pdf
    istex:673D51F691641770F942C818E8887705C7116F16
    PMID:11950733
    ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-Feature-2
    content type line 23
    ObjectType-Article-2
    ObjectType-Feature-1
    Contributors: CL initiated the research, participated in the protocol design, coordinated patient recruitment, performed transvaginal scans, provided counselling, collected and analysed data, and contributed to writing the paper. KJ participated in the protocol design, performed transvaginal scans, and provided counselling. CM participated in the collection of data and analysis of results. GC performed transvaginal scans and provided counselling. WC interpreted, discussed, and presented the data and contributed to writing the paper. TB coordinated the preparation of the protocol, discussed core ideas, analysed data, and contributed to writing the paper. THB is the guarantor.
    Correspondence to: T Bourne tbourne@gynae-scanning.com
  • Descrição: Abstract Objectives: To evaluate the uptake and outcome of expectant management of spontaneous first trimester miscarriage in an early pregnancy assessment unit. Participants: 1096 consecutive patients with a diagnosis of spontaneous first trimester miscarriage. Methods: Each miscarriage was classified as complete, incomplete, missed, or anembryonic on the basis of ultrasonography. Women who needed treatment were given the choice of expectant management or surgical evacuation of retained products of conception under general anaesthesia. Women undergoing expectant management were checked a few days after transvaginal bleeding had stopped, or they were monitored at weekly intervals for four weeks. Main outcome measures: A complete miscarriage (absence of transvaginal bleeding and endometrial thickness <15 mm), the number of women completing their miscarriage within each week of management, and complications (excessive pain or transvaginal bleeding necessitating hospital admission or clinical evidence of infection). Results: Two patients with molar pregnancies were excluded, and 37% of the remainder (408/1094) were classified as having had a complete miscarriage. 70% (478/686) of women with retained products of conception chose expectant management; of these, 27 (6%) were lost to follow up. A successful outcome without surgical intervention was seen in 81% of cases (367/451). The rate of spontaneous completion was 91% (201/221) for those cases classified as incomplete miscarriage, 76% (105/138) for missed miscarriage, and 66% (61/92) for anembryonic pregnancy. 70% of women completed their miscarriage within 14 days of classification (84% for incomplete miscarriage and 52% for missed miscarriage and anembryonic pregnancy). Conclusions: Most women with retained products of conception chose expectant management. Ultrasonography can be used to advise patients on the likelihood that their miscarriage will complete spontaneously within a given time.
  • Editor: London: British Medical Journal Publishing Group
  • Idioma: Inglês
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