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P414 Assessment of conservative management of first trimester miscarriage in Sudanese women
Author(s) -
Gasim M. Abul,
Soliman N.,
Bashir A. Fazari
Publication year - 2009
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/s0020-7292(09)61906-8
Subject(s) - miscarriage , medicine , citation , library science , obstetrics and gynaecology , obstetrics , pregnancy , computer science , genetics , biology
Objective: To evaluate the efficacy of conservative management versus surgical management of first trimester miscarriage in Sudanese women. Methods: Prospective analytical facility based study. 216 Patients offered conservative and surgical management. Following counseling we enrolled 115 for expectant, 36 for surgical and 30 for medical management, a total of 181 drop out 35. Written consents taken, fulfillment of inclusion criteria and ethical clearance obtained. Oral antibiotics and paracetamol prescribed to all patients. Ante D if Rhesus negative given. The expectant group left the facility when pain free and bleeding settled. The medical group allowed home if no or minimal bleeding. Haemoglobin at presentation and after the study was recorded. Patient satisfaction assessed four weeks later and contraception offered. Results: 79 % had incomplete, 15.5% missed and 5.5% inevitable. 63.5% expectant management, 19.9% surgical evacuation and 16.6% given misoprostol. Complete evacuation highest in medical group 93.3% in surgical group 91.6% and in expectant group 80%. Surgical evacuation was done in 7% of expectant group. 13% of failed expectant group had complete miscarriage after misoprostol. Two cases of missed abortion needed a re-evacuation. Two in medical group had emergency curettage. One patient in surgical group blood transfused. Patient satisfaction was 85%, 60% in expectant and surgical group respectively. Conclusion: Medical management is more likely to induce complete evacuation of the uterus and reduce the need for surgical evacuation. Expectant management was accepted by the clients. A prophylactic antibiotic is important. We recommend the Manual Vacuum Aspiration and medical management in our facility.