Introduction
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Miscarriage is usually a distressing experience. Emotional support and care is essential throughout the course of assessment, decision-making and treatment.
For many women diagnosed with miscarriage, more than one of the options of expectant, medication or surgical management may be appropriate. Care should include information and advice about options which are medically appropriate for each woman’s particular situation and support in decision-making. In many circumstances a decision is not clinically urgent; women can be given time to come to terms with the diagnosis and reach a decision about mode of management.
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Although surgical curettage has been standard care for more than 50 years, there is now good evidence that expectant and/or medication management can be appropriate and are preferable for some women. Routine curettage was predicated on a belief that to do otherwise was associated with unacceptable risks of intrauterine infection. It is likely that many of the infections seen historically in association with miscarriage resulted from illegal abortions. Access to safe legal pregnancy termination has largely solved this problem when available. Uncomplicated spontaneous miscarriage appears to be accompanied by a low risk of infection and surgical evacuation is itself accompanied by risks, including those of infection. Much of the understanding and development of treatment regimens in this area is based on or extrapolated from regimens for medication abortion.
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Purpose
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To guide clinicians in the care of women who have been diagnosed with a miscarriage (for assessment and diagnosis refer to CPG: Pain and Bleeding: Early Pregnancy).
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The CPG is presented as a PDF. An index is provided.
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| | | | | | | | 4. Clinical presentation and diagnosis
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| | 5. Other investigations and treatment
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| | 6. Selecting an appropriate management method
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| | | | | | 7.2 Medication management
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| | 7.3 Surgical management (suction curettage)
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Guideline
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Consumer information
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Resources
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Clinical Practice Guidelines
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References
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- Bourne T, Condous G. Handbook of Early Pregnancy Care. Informa Healthcare, 2006.
- Neilson JP, Hickey M, Vazquez J. Medical treatment of early fetal death(less than 24 weeks).Cochrane Database of Systemic Reviews 2006, Issue 3.Art. No.:CD002253.DOI:10.1002/14651858.CD002253.pub3
- Royal College of Obstetricians and Gynaecologists. The Management of Early Pregnancy Loss. Guideline No. 25.London: RCOG; 2006.
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Revised and published:
7 October 2010
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Royal Women's Hospital Clinical Practice Guidelines (CPGs) are intended to provide guidance to health care professionals, based on a thorough evaluation of research evidence, on the practical assessment and management of specific clinical issues or situations. The guidelines allow some flexibility on the part of the health care professional based on the needs of the specific patient for whom they are caring.
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