Expectant care versus surgical treatment for miscarriage

Increasing the management options for early pregnancy loss: the economics of miscarriage

“…[4][5][6][7] Expectant management has the greatest variation in success rates, ending in a completed miscarriage for 38-81% of patients. [8][9][10] Although expectant management has been shown to increase overall days of bleeding and the risk of unscheduled surgical intervention or hospitalization, 8,11 patient satisfaction rates remain high for all approaches. 7,8,12,13 Obviously, a patient's presentation may strongly dictate management-at times, surgical evacuation in the operating room may be required for a patient with profound bleeding.…”

“…[8][9][10] Although expectant management has been shown to increase overall days of bleeding and the risk of unscheduled surgical intervention or hospitalization, 8,11 patient satisfaction rates remain high for all approaches. 7,8,12,13 Obviously, a patient's presentation may strongly dictate management-at times, surgical evacuation in the operating room may be required for a patient with profound bleeding. However, most patients with EPL are not diagnosed in the midst of an acute episode requiring immediate surgical intervention.…”

“…Despite lower overall success rates when compared with surgical evacuation, patient satisfaction rates are consistently high for both medical and expectant management. 8,12,13 Inherent risks are involved in surgical evacuation, including bleeding, discomfort, cervical laceration, uterine perforation, and potential risks of anesthesia. Patients may feel intimidated by the operating room setting, or simply prefer the privacy of managing their pregnancy loss at home.…”

Pitfalls in First-Trimester Bleeding

“…This often slows vaginal bleeding considerably. 29 Dilation with suction curettage (D&C), however, is the definitive procedure to prevent hemorrhage and infection with retained products of conception. The risks of this procedure include those of procedural sedation, uterine adhesions and perforation, and cervical trauma and infection.…”

“…A Cochrane database showed that although there was a higher rate of return for surgical procedures and bleeding, expectant management was the favorite of most women, with 50% of women choosing it. 29 Approximately 50% of all pregnant patients who come to the ED with vaginal bleeding eventually miscarry. As there are no therapies to prevent a miscarriage, expectant management is the accepted course for all threatened abortions.…”