Medical versus surgical termination of the first trimester missed miscarriage

Abstract

Using dilatation and curettage (D&C) without prior cervical ripening in the termination of the first trimester missed miscarriage may often cause a concern because of the associated complications. Our aim of this study was to compare the frequency of complications of dilatation and curettage with medical method. A prospective comparison study was carried out in Al-Thawra General Hospital Sana’a over a year (from Dec. 1st 2010 to Nov. 31st 2011). Eligible women were randomized into surgical group (n= 55) and medical group (n= 52). Misoprostol 400 lg was given for the medical group intravaginally as initial dose followed by 200 lg every 4 h vaginally. Dilatation and curettage was performed for the surgical group. All participants were invited to attend a follow-up visit one week later. The complications were recorded during the procedure, before discharge and at follow-up. The success rate of medical group was 80.7% (95%, CI: 69.97–91.43) and 100% for the surgical group. Infection had occurred in 3.8% of the medical vs. 1.8% of the surgical group (p=0.967), hemorrhage was recorded in 7.7% vs. 5.4% of the medical and surgical group respectively (p=0.928). Only one patient of the medical group required readmission for blood transfusion. The mean induction abortion time was 20.4 ± 8.3 h. No other major complication was observed in both groups. We concluded that dilatation and curettage is safe and acceptable in terms of more rapid evacuation and lower complication rates compared to medical method

Keywords: Medical termination of first trimester; Misoprostol; Miscarriage