Management of Women With an Incomplete Miscarriage
Status:
Completed
Trial end date:
2019-07-01
Target enrollment:
Participant gender:
Summary
Miscarriage is defined as the spontaneous loss of a pregnancy before 24 weeks' gestation,
that is, before the fetal viability. The clinical signs of miscarriage are usually vaginal
bleeding associated abdominal pain and cramping . The miscarriage is named 'complete' or
'incomplete' according to whether or not tissues are retained in the uterus. If a woman has
minimal bleeding but her cervix is closed, this is known as a 'threatened miscarriage.
However; if the pregnancy is still inside the uterus but the cervix is open, this is
described as an 'inevitable miscarriage', which it will not usually be possible to save the
fetus.
From many years, the surgical curettage ('evacuation of the uterus') was considered the 'gold
standard management' for miscarriage to remove the retained placental tissue. It is quickly
performed and removed almost all the retained products of conception. However, the routine
surgical evacuation of the uterus associated with higher rate of morbidity and mortality and
should be limited for special indications.
Many studies compared the effectiveness of medical treatment compared to surgery in
management of incomplete abortion. There is only one study compared the curettage with
expectant management in those women after medical therapy.However; none of them, looked at
the effectiveness of the second chance of medical treatment in management of incomplete
abortion in trial to avoid the surgical intervention after failure of previous medical
treatment. So we think that the immediate evacuation using surgical intervention is truly
unnecessary in most cases of failed medical abortion and the patients may get benefit from
another trial of medical treatment.