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Incomplete miscarriage, expectant versus medical management and the use of Doppler sonography for patient selection | ||
| IRAQI JOURNALOF COMMUNITY MEDICINE | ||
| Article 1, Volume 29, Issue 2, 2016, Pages 10-15 | ||
| Author | ||
| Ban H Hameed | ||
| Abstract | ||
| Background: Miscarriage is the most common complication of early pregnancy, and remains an important clinical problem. Knowledge of the pathophysiology of this is limited and therefore therapeutic regimens are based on few data. Objective: To study patients with first trimester incomplete miscarriage and to evaluate whether expectant or medical management is a feasible strategy and to assess the value of Colour Doppler ultrasonography for patient selection. Patients and Method: A prospective comparative study of a total of 100 pregnant women with an estimated gestation age of up to 13 weeks from the last menstrual period (LMP) attending Al Yarmouk teaching hospital from November 2011 to November 2012, after confirmation of the diagnosis by transvaginal sonography, the patients were divided into two groups: expectant and medical management groups. The ultrasound examination included Colour Doppler Imaging to evaluate the vascularity of retained products. Results: Out of a total of 100 women recruited, 50 patients (50%) elected to expectant management and 50 patients (50%) for medical management. The treatment groups were similar in age, gestational age, and proportion of patients who had post-treatment complications (12–13%). By 4 weeks after inclusion, 42 patients (84%) in the expectant management group had undergone a spontaneous complete miscarriage and 8 patients (16%) had undergone surgical evacuation. While in the medical management group, 46 patients (92%) had undergone complete miscarriage and 4 (8%) had undergone surgical evacuation. 54.3% of cases with detectable presumed intervillous pulsatile blood flow had a complete, spontaneous miscarriage within 1 week; this occurred in 77.8% of cases with no detectable flow. This suggests that conservative management is a successful approach for patients with first trimester incomplete miscarriage; Colour Doppler ultrasonography can be used to select the most suitable patients for this strategy, and thus reduces the need for hospital admission, surgery and prolonged follow up | ||
| Keywords | ||
| Incomplete miscarriage | ||
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