الفهرس 
Pregnancy loss (Miscarriage)Only 14 pages are availabe for public view
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Abstract
: The aim of our study was to compare and assess the incidence of unplanned uterine curettage between expectant management versus medical and surgical management within of first trimester missed and incomplete miscarriage. Patients and Methods: This Randomized controlled trial included 150 patients diagnosed with early fetal demise at less than 13 weeks’ gestation. They were recruited and assessed for eligibility from Ain Shams University Maternity Hospital. Cases were randomized according to a computer-generated random sequence into three groups; Expectant, Surgical and Medical groups. Primary clinical outcome in the expectant, surgical and medical groups included the incidence of hospital re-admission for unplanned uterine curettage. Secondary clinical outcomes included a) Documenting the incidence of gynaecological infection within 14 days and 8 weeks (the gynaecological infection defined as two or more of purulent vaginal discharge, pyrexia (above 38⁰C), tenderness over the uterus on abdominal examination, and a white blood cell count above 15 X 109/L). b) The treatment with antibiotics for presumed gynaecological infection within 14 days and eight weeks. c) The duration of clinical symptoms (pain, additional analgesia, vaginal bleeding). d) Complications (fall in haemoglobin at 10-14 days, blood transfusion, unplanned consultations or admissions within 14 days and within eight weeks). e) Efficacy (defined as a successful outcome as no unplanned surgical curettage within eight weeks.
Results: Our results indicated statistically significant difference (P<0.05) between studied groups as regard vaginal bleeding as a symptom of miscarriage. Regarding the
post-intervention bleeding duration per days among the studied groups, our results indicated that bleeding duration was highly significant and the longest among the expectant group followed by the medical then the surgery groups (P<0.001). Our results indicated the presence of statistically significant difference (p-value < 0.05) between studied groups as regard failed treatment and shift to surgery that was more prevalent in the expectant group followed by the medical group. Our results indicated no statistical significant difference between studied groups (expectant, medical and
surgical groups) as regard emergency unplanned D&C due to heavy bleeding (p-value >
0.05).
Conclusion: The incidence of failed treatment and shift to surgery after expectant, medical and surgical management of spontaneous first trimester miscarriage was more prevalent in the expectant group followed by the medical group then the surgical group. Regarding complications, our results indicated a highly statistical significant difference between studied groups as regard hypotension. It was more prevalent in medical group followed by the expectant group then the surgical group.