Fast Is Better for First-Trimester Miscarriage

Miscarriage treatment can help women avoid surgery

(RxWiki News) Miscarrying a child is a difficult, emotional experience for a woman. Some women who experience first-trimester loss choose to lose the baby naturally, without immediate medical intervention.

But French researchers say this delayed approach may not be the most effective way to treat miscarriage.

Doctors from Paris Ile de France Ouest School of Medicine and other institutions studied 174 women with first-trimester miscarriage to find out whether delayed medical treatment – instead of immediate medical treatment – lowered the need for surgery to remove tissue from the uterus.

The team found that postponing medical treatment doubled the risk for surgery and quadrupled the need for emergency intervention.

"Prenatal care is essential; keep all your appointments."

Standard treatment for early miscarriage includes medication and “watchful waiting.” If surgery is necessary, a doctor will perform vacuum aspiration in which tissue is gently suctioned from the uterus.

The researchers had believed that combining two miscarriage treatment methods might reduce the need for surgical treatment. These two methods are “initial expectant management,” in which a woman allows the miscarriage to progress naturally over the course of 2-4 weeks, followed by medication.

They tracked patients who underwent spontaneous miscarriage before 14 weeks of pregnancy. About half of the women were given immediate medical treatment over a one-week period: They received 200 mg of mifepristone orally and a vaginal dose of 400 micrograms (mcg) of misoprostol two days later.

If embryonic tissue still showed at an ultrasound five days later, then the patient was given vacuum aspiration.

The second half of the group did not receive any immediate medical treatment. An ultrasound was administered on each woman after one week, and women with remaining embryonic tissue were given medication. If such tissue still remained after another week, as determined by ultrasound, then the woman received vacuum aspiration.

About 19% of the women who received immediate medical treatment needed vacuum aspiration during or at the end of treatment. In contrast, about 44% of women who received delayed treatment needed vacuum aspiration. Women who received delayed treatment were also more likely to need emergency surgery: 20% of these women underwent the emergency procedure, compared to approximately 5% in the immediate-treatment group.

The researchers also report that treatment was more effective when performed immediately (81% success rate) compared to delayed treatment (53%).

This was the most striking finding of our research, says Dr. Antoine Torre of Paris Ile de France Ouest School of Medicine and colleagues in the paper.

Delaying treatment also resulted in twice as many visits to the emergency room.

In light of the study’s findings, the authors say that immediate medical and surgical treatment should be carried out once first-trimester miscarriage has been diagnosed.

This study will publish in the March issue of American Journal of Obstetrics & Gynecology and funded by Assistance Publique Hopitaux de Paris.

Review Date: 
March 1, 2012