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Clinical and psychological impact after surgical, medical or expectant management of first‐trimester miscarriage – a randomised controlled trial
Author(s) -
Kong Grace Wing Shan,
Lok Ingrid Hung,
Yiu Alice Ka Wah,
Hui Annie Shuk Yi,
Lai Beatrice Pui Yee,
Chung Tony Kwok Hung
Publication year - 2013
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/ajo.12064
Subject(s) - medicine , miscarriage , anxiety , obstetrics , beck depression inventory , randomized controlled trial , misoprostol , pregnancy , psychological intervention , medical abortion , patient satisfaction , abortion , clinical trial , depression (economics) , physical therapy , surgery , psychiatry , genetics , macroeconomics , pathology , economics , biology
Background The management of first‐trimester miscarriage has been studied extensively in recent years. However, relatively little attention has been focussed on woman's satisfaction and psychological impact from different treatment modalities. Aim To investigate the clinical and psychological outcomes of surgical, medical and expectant management of first‐trimester miscarriage. Materials and Methods A prospective randomised controlled trial of 180 women suffering miscarriage managed by either surgical evacuation, medical evacuation or expectant management was conducted in a university‐affiliated, tertiary referral hospital. The complete miscarriage rate, clinical symptomatology, complications, women's satisfaction and the psychological impact were evaluated. Results Women in surgical evacuation (98.1%) had a significantly higher complete miscarriage rate when compared with medical evacuation (70%) and expectant management (79.3%). Women who had surgical evacuation had significantly shorter duration of vaginal bleeding, but higher rate of infection. Women who had medical evacuation had significantly more gastrointestinal symptoms. Despite differences in efficacy and complication profile, there was no significant difference in satisfaction among groups. There were no significant differences in terms of psychological well‐being, depression scores, anxiety level, fatigue symptoms as measured in General Health Questionnaire‐12, Beck Depression Inventory, Spielberger's State Anxiety Inventory and fatigue scale at treatment and four weeks after treatment. However, women with active intervention had greater post‐traumatic stress symptoms as measured in Chinese version of Impact of Event Scale – Revised at the time of treatment when compared with women in expectant management. Conclusion Without substantial differences in the clinical and psychological impact between different treatment modalities, a more conservative approach with expectant management for miscarriage may be an option for women.