BMJ 2001;322:1343-1346 ( 2 June )

Clinical review

Regular review

Management of spontaneous miscarriage in the first trimester: an example of putting informed shared decision making into practice

Editorial by Cahill

Willem M Ankum, gynaecologist ^a, Margreet Wieringa-de Waard, general practitioner ^b, Patrick J E Bindels, general practitioner ^b. 

^a Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, Netherlands, ^b Department of General Practice, Academic Medical Centre, University of Amsterdam

Correspondence to: W M Ankum w.m.ankum@amc.uva.nl

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

In many parts of the Western world there is a strong preference among gynaecologists to rely on surgical evacuation for the management of miscarriages in the first trimester. Why so many specialists have adopted surgery as the standard procedure seems determined by custom and habit and rooted in history rather than being an evidence based choice. During the first half of the 20th century the high rate of infections from retained products of conception with ensuing mortality from septicaemiaoften complications from criminal attempts to terminate a pregnancyresulted in the policy of immediate surgical evacuation whenever a diagnosis of inevitable abortion was made.¹ Today these complications are rare, and their role in the justification of a universal tendency to perform surgery has therefore expired.²

Expectant management finds its main protagonists in general practice, where the process of spontaneous miscarriage is acknowledged more readily as being a well regulated natural . . . [Full text of this article]

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