Surgical treatment versus expectant care in the management of incomplete miscarriage: a randomised controlled trial

Abstract

Objectives: To determine whether expectant care of incomplete miscarriages can significantly reduce the need for surgical evacuation of retained products of conception (ERPC) without increasing complications.

Methods: A randomized controlled trial conducted at the University Unit, Teaching Hospital Mahamodara, Galle. Consecutive women with uncomplicated incomplete miscarriages at < 14 weeks period of amenorrhoea (POA), admitted from 01 January to 15 July 2009 with retained products of conception (RPC) measuring 15-50 mm in the anteroposterior (AP) diameter on transvaginal sonography (TVS) were randomised to ERPC under general anaesthesia (n=80) and expectant care (n=80) groups. Both groups were reviewed after one week clinically and with TVS. The expectant care group was reviewed weekly up to four weeks unless complete expulsion of RPC was confirmed earlier.

Results: Age, parity, POA, socio-economic status, distance of residence from the hospital and the AP diameter of RPC at recruitment were similar in both groups. In the expectant care group, complete expulsion of RPC occurred within one week in 69%, and three patients needed ERPC. One patient in the ERPC group required a repeat ERPC. The durations of abdominal pain and the days off normal work were similar in both groups. The expectant care group had a longer duration of vaginal bleeding (p < 0.01) than the ERPC group. Complications were rare and similar in both groups and not of clinical significance.

Conclusion: Expectant care in the management of uncomplicated first trimester incomplete miscarriage is safe and effective with no significant short-term complications.