[Curettage or not after spontaneous abortion?]

Abstract

Background: In most cases of miscarriage, standard procedure has until recently been surgical revision of the uterine cavity.

Material and methods: 94 women with first trimester miscarriage were randomized to surgical revision (n = 48) or expectation (n = 46) after informed consent. Women with unacceptable pain or bleeding, or uterine contents of more than 20 mm diameter on sonography were not included. The patients were followed up seven to ten days later with gynaecological examination, sonography, and determination of levels of haemoglobin, leukocytes, C-reactive protein and HCG.

Results: In the revision group there were no operative complications, no cases of infection, and no unscheduled consultations. Mean duration of bleeding was 4.8 days (range 1-11 days). In the observation group there were no cases of infection, surgical revision was carried out in seven patients, and there were six unscheduled consultations. Mean duration of bleeding was 7.3 days (range 2-27 days). The women undergoing surgical revision had less pain and bleeding.

Interpretation: Women with first trimester miscarriage may safely be observed without surgical revision but may have somewhat more pain and more vaginal bleeding than if revision is carried out.