Book contents
- Frontmatter
- Contents
- About the authors
- Acknowledgements
- Abbreviations
- Preface
- 1 Organisation and delivery of emergency care in early pregnancy and acute gynaecology
- 2 Epidemiology and aetiology of miscarriage and ectopic pregnancy
- 3 Diagnosis of miscarriage
- 4 Conservative and surgical management of miscarriage
- 5 Management of hyperemesis gravidarum
- 6 Diagnosis and treatment of recurrent miscarriage
- 7 Differential diagnosis and management of molar pregnancy
- 8 Drugs in early pregnancy
- 9 Diagnosis of tubal ectopic pregnancy
- 10 Conservative management of tubal ectopic pregnancy
- 11 Surgical management of tubal ectopic pregnancy
- 12 Diagnosis and management of non-tubal ectopic pregnancy
- 13 Diagnosis and management of acute pelvic pain
- 14 Management of vaginal bleeding in the acute clinical setting
- 15 Current concepts in screening and outpatient management of pelvic inflammatory disease
- 16 Diagnosis and management of haemorrhagic and septic shock
- 17 Role of minimally invasive surgery in acute gynaecology
- Index
4 - Conservative and surgical management of miscarriage
Published online by Cambridge University Press: 05 July 2014
- Frontmatter
- Contents
- About the authors
- Acknowledgements
- Abbreviations
- Preface
- 1 Organisation and delivery of emergency care in early pregnancy and acute gynaecology
- 2 Epidemiology and aetiology of miscarriage and ectopic pregnancy
- 3 Diagnosis of miscarriage
- 4 Conservative and surgical management of miscarriage
- 5 Management of hyperemesis gravidarum
- 6 Diagnosis and treatment of recurrent miscarriage
- 7 Differential diagnosis and management of molar pregnancy
- 8 Drugs in early pregnancy
- 9 Diagnosis of tubal ectopic pregnancy
- 10 Conservative management of tubal ectopic pregnancy
- 11 Surgical management of tubal ectopic pregnancy
- 12 Diagnosis and management of non-tubal ectopic pregnancy
- 13 Diagnosis and management of acute pelvic pain
- 14 Management of vaginal bleeding in the acute clinical setting
- 15 Current concepts in screening and outpatient management of pelvic inflammatory disease
- 16 Diagnosis and management of haemorrhagic and septic shock
- 17 Role of minimally invasive surgery in acute gynaecology
- Index
Summary
Introduction
For the past 50 years, the mainstay of treatment for the management of miscarriage has been surgical management, or the evacuation of retained products of conception. Until recently, up to 88% of women diagnosed with a miscarriage would be offered an evacuation of retained products of conception under general anaesthesia. The rationale for surgical management was based on the assumption that the presence of a non-viable pregnancy within the uterus would increase the risk of infection and haemorrhage. In the past, these complications were more likely to develop from infected retained products of conception following poorly performed illegal abortions but, with the legalisation of abortion in developed countries, the introduction of antibiotics and a general improvement in women's health, these risks have decreased substantially. Over the past decade, there has been less emphasis on urgent surgical management and more on individualised treatment and patient choice between expectant, medical and semi-elective surgical treatment.
Expectant management
Expectant management is chosen by women because of a desire for a natural approach to management. It is becoming an increasingly popular option; in one observational study, 70% of women opted to wait for the pregnancy to resolve spontaneously. The first randomised controlled trial of expectant management compared with surgical management of miscarriage, carried out by Nielsen and Hahlin, showed a 79% success rate for cases of incomplete or inevitable miscarriage when managed expectantly for 3 days, with no increased risk of pelvic infection or excessive bleeding.
- Type
- Chapter
- Information
- Acute Gynaecology and Early Pregnancy , pp. 37 - 48Publisher: Cambridge University PressPrint publication year: 2011