The impact of introducing medical management on conservative and surgical management for early pregnancy miscarriage

BackgroundMedical management of miscarriage allows women to avoid the risks associated with surgical intervention. In 2011 the early pregnancy assessment service (EPAS) at the Royal Prince Alfred Hospital (RPAH) in Sydney, Australia introduced medical management of miscarriage with single-dose 800g vaginal misoprostol. AimsWe sought to investigate the impact of the introduction of medical management had on the proportion of women having surgery and conservative management and to examine the success and complication rates of medical management. Materials and methodsWe undertook a retrospective cohort study that included all women diagnosed with a miscarriage from 12months prior to and 18months after the introduction of medical management. Successful management was defined as the absence of retained products of conception or endometrial thickness less than 15mm on ultrasound at two weeks. The change in management choices over time, the success rates and complication rates were measured. ResultsOf 1102 women in the final analysis, 446 were in Group A (before medical management) and 656 in Group B (after medical management). Primary surgical procedures fell significantly for missed miscarriages from 68 to 48% (P<0.001) and primary conservative management reduced for incomplete miscarriages (63-44%; P=0.01). Overall 89 of 108 (82.4%) patients managed medically had a resolution within two weeks. One in ten presented with a complication. DiscussionThe introduction of medical management led to a statistically significant reduction in the proportion of women undergoing primary surgical management of missed miscarriage. Success and complication rates were similar to other studies.