Expectant, Medical, or Surgical Treatment of Spontaneous Abortion in First Trimester of Pregnancy? A Pooled Quantitative Literature Evaluation

Abstract

Background: Spontaneous abortion is a common problem in everyday clinical practice, accounting for 15 to 20 percent of all recognized pregnancies. The traditional treatment of this problem has been surgical, emptying the uterus by dilatation and curettage (D&C). Recent therapeutic and laboratory advances call surgical therapy into question for many patients. It is believed that this pooled quantitative literature evaluation is the first with the goal to clarify the roles of expectant, medical, and surgical treatment of this common problem.Methods: The literature review was focused on published studies in the English language of outcomes of therapy for spontaneous abortion in the first trimester. We looked for both observational and randomized controlled trials. A successful outcome of treatment required that three criteria be met: vaginal bleeding stopped by 3 weeks, products of conception fully expelled by 2 weeks, and absence of complications. Pooled weighted average success estimates and standard errors were determined for each study; 95 percent confidence intervals were calculated for each form of treatment. Sensitivity analysis compared randomized controlled trials with observational studies for both expectant and surgical treatment.

Incidence of pregnancy after expectant, medical, or surgical management of spontaneous first trimester miscarriage: long term follow-up of miscarriage treatment (MIST) randomised controlled trial

“…1 This was increasingly questioned, [2][3][4] and now women are usually offered expectant (watch and wait, no active inter vention) 5 6 and medical 7 8 management as well. Trials have suggested that all three methods are probably equivalent in terms of gynaecological infection, [9][10][11][12][13] including the largest trial, which recruited around 1200 women (the miscarriage treatment (MIST) trial). 14 Little published evidence, however, has assessed the effect of management method on subsequent fertilitya key issue for women and those responsible for their care.…”

Paternal Exposure to Ribavirin: Pregnancy and Neonatal Outcome

“…In our experience, spontaneous abortion rate does not increase (1/8 vs 4/6 by Maddrey) [13] and neither of the newborns shows specific congenital malformations. Even if our data are limited, they are the most numerous group of babies conceived during or within 3 months after the end of paternal ribavirin exposure.…”

Medical Abortion in Family Practice: A Case Series

“…17 Another explanation might be that the physicians in the research trials were also providers of surgical abortion and thus more comfortable with suction procedures. Generally, family physicians provide expectant management of spontaneous abortion more often than gynecologists, with comparable, safe outcomes, 18,19 and so we would expect this comfort with expectant management to apply to medical abortion as well.…”