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The medical management of missed miscarriage: outcomes from a prospective, single‐centre, Australian cohort
Author(s) -
Petersen Scott G,
Perkins Anneliese R,
Gibbons Kristen S,
Bertolone Julia I,
Mahomed Kassam
Publication year - 2013
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja12.11813
Subject(s) - medicine , miscarriage , misoprostol , obstetrics , prospective cohort study , products of conception , cohort , pregnancy , cohort study , gestation , gynecology , abortion , surgery , genetics , biology
Abstract Objective: To report the prospective outcomes of medical management of missed miscarriage before 13 weeksˈ gestation from an Australian cohort. Design: Descriptive study of a cohort selected out of a randomised controlled trial. Setting: Outpatient management at a maternity hospital between 1 May 2007 and 28 July 2010. Participants: 264 women requesting medical management of missed miscarriage. Main outcome measures: Number of doses of misoprostol required, unscheduled visits for care, findings at ultrasound follow‐up, requirement for surgical management, number of cases of gestational trophoblastic disease (GTD), and self‐reported patient experience. Results: 107 women (40.5%) received a repeat dose of misoprostol, and 79 women (29.9%) made unscheduled visits for care. Among the 241 women with Day 7 ultrasound follow‐up, a gestational sac was found in 32 women (13.3%), indicating failure of medical management. Complete miscarriage was induced without the need for surgery in 206 women (78.0%). Surgery was performed as an emergency in 13 women (4.9%). Twelve women (4.5%) had surgery for ongoing bleeding after medical management, and four of these did not have chorionic villi on histopathological examination. Five women (1.9%) had GTD, which was managed incidentally under the protocol. Among those who returned patient questionnaires, 73.0% participants (116/159) indicated that they would recommend medical management of miscarriage to other women, while 18.2% (29/159) indicated that they would undergo surgery next time. Conclusion: The medical management of missed miscarriage on an outpatient basis is safe and effective. Trial registration: ACTRN12612000150842.