9 September 2013
Australia: The medical management of missed miscarriage
This study set out to report the prospective outcomes of medical management of missed miscarriage before 13 weeks' gestation from an Australian cohort. From Medical Journal of Australia.
It was a descriptive study of a cohort selected out of a randomised controlled trial, set in outpatient management at a maternity hospital between 1 May 2007 and 28 July 2010.
Participants were 264 women requesting medical management of missed miscarriage. The main outcome measures were number of doses of misoprostol required, unscheduled visits for care, findings at ultrasound follow-up, requirement for surgical management, number of cases of gestational trophoblastic disease (GTD), and self-reported patient experience.
The results found that 107 women (40.5%) received a repeat dose of misoprostol, and 79 women (29.9%) made unscheduled visits for care. Among the 241 women with Day 7 ultrasound follow-up, a gestational sac was found in 32 women (13.3%), indicating failure of medical management. Complete miscarriage was induced without the need for surgery in 206 women (78.0%). Surgery was performed as an emergency in 13 women (4.9%). Twelve women (4.5%) had surgery for ongoing bleeding after medical management, and four of these did not have chorionic villi on histopathological examination. Five women (1.9%) had GTD, which was managed incidentally under the protocol. Among those who returned patient questionnaires, 73.0% participants (116/159) indicated that they would recommend medical management of miscarriage to other women, while 18.2% (29/159) indicated that they would undergo surgery next time.
The authors concluded that the medical management of missed miscarriage on an outpatient basis is safe and effective.
The medical management of missed miscarriage: outcomes from a prospective, single-centre, Australian cohort. Petersen SG, Perkins AR, Gibbons KS, Bertolone JI, Mahomed K. Medical Journal of Australia. 2013 Sep 2;199(5):341-6.