Managing spontaneous first trimester miscarriage

doi:10.1136/bmj.322.7298.1315

BMJ 2001;322:1315-1316 ( 2 June )

Editorials

Managing spontaneous first trimester miscarriage

We don't yet know the optimal management

Clinical review p 1343

The first 150 words of the full text of this article appear below.

Spontaneous miscarriage (inevitable or incomplete) and early fetal demise (previously called missed abortion)¹ are componentsof pregnancy loss in the first trimester. For most of the 20thcentury spontaneous miscarriage was managed by evacuation of retainedproducts of conception. Traditionally carried out with ovum forcepsand curettage, this method changed to vacuum aspiration afteradvances were made in the equipment to deal with surgical terminationof pregnancy. The belief that retained products always neededto be evacuated after spontaneous miscarriage developed becauseof the two major complications of inappropriately managed miscarriage,bleeding, and infection. However, changes in public health andmedical practice have led to questioning of this dogma. Do allwomen really need evacuation of retained products? And if not,how can we decide who does require it? How likely are complicationsto arise if evacuation is undertaken $---$ or if it isnot?

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