Medical and Surgical Treatment of Firsttrimester Silent Miscarriage: a Three-year Review

Abstract

Objective: The primary objective was to compare the overall efficacy (including frequency of side-effects and complications) following medical and surgical treatment of first-trimester silent miscarriage in the Department of Obstetrics and Gynaecology, Tseung Kwan O Hospital, Hong Kong. The secondary objective was to evaluate any demographic differences between women opting for medical or surgical treatment and identify any clinical and / or ultrasonographic factors predictive of successful medical treatment.
Methods: A retrospective review was conducted on individual patient records of women treated between January 2006 and December 2008. Data of women receiving medical and surgical treatment were analysed and major parameters such as success (clinical outcome, side-effects) and demographic characteristics were compared. Appropriate statistical tests were applied. A p value of less than 0.05 was regarded as statistically significant.
Results: Of 173 women whose records were analysed, 70 received medical treatment and 73 were treated surgically. The success rates of medical and surgical treatments were 79% and 99%, respectively. In the medical treatment group, the median interval between misoprostol to passage of the tissue mass was 8 hours; 86% passed the mass during hospitalisation, and the median duration of vaginal bleeding was 14 days. The most common side-effect was fever (54%), abdominal pain (31% received oral analgesics and 11% received parenteral analgesia), and vomiting (7%), which were significantly more common than women treated surgically. Respective frequencies for medical and surgical groups were diarrhoea (4% vs 0%), nausea (4% vs 0%), emergency readmission (6 vs 4%), antibiotic treatment for presumed infection (11 vs 7%), and interval till return of menstruation (34 vs 31 days). Nulliparous women had a higher preference for medical treatment (p = 0.02; odds ratio = 2.2; 95% confidence interval, 1.1-4.4). None of the clinical or ultrasonographic features could effectively predict successful
outcomes for medical treatment.

Conclusion: Both medical and surgical treatment had success rates comparable to published studies. Side-effects were significantly higher in those opting for medical treatment. Most side-effects were self-limiting. Nulliparous women had higher preference for medical treatment. No clinical or ultrasonographic feature was predictive of the success of medical treatment.