Management of first trimester miscarriage after implementation of a standardized protocol in a tertiary hospital in Cape Town, South Africa – an observational study

[摘要] BackgroundSpontaneous first trimester miscarriage is common problem in primary care and emergencysettings. Management options have changed over time and now include surgical, medical and expectant management options.AimTo assess the effectiveness and complications of these various choices for women with first trimester miscarriages who present to an acute and outpatient early pregnancy service, Tygerberg hospital, a tertiary level public hospital in Cape Town, South Africa. Prior to this the standard practice was surgical management of first trimester miscarriagesMethodsA protocol introducing the various management options of first trimester miscarriages was created and implemented, and an audit was carried out over six months to assess outcomes between January 2015 and June 2015. Data was captured and analyzed with SPSS software using Kaplan-Meier analysis and Pearson Chi-square test.ResultsOf the 157 women whose management of their miscarriage was assessed, 32% had surgical,40% had medical and 28% had expectant management. Median days until complete miscarriage was 1 [1 -66 days] for surgical, 10 [1 – 105 days] for medical and 18 [1 – 66 days] for expectant management. All patients who chose initial surgical management completed the miscarriage in that category. Seventy-five percent of women who intended medical management and 18.4% who chose expectant management successfully completed the miscarriage as initially planned. The remainder completed their miscarriages in themedically or surgically. Complication rates included: 10.2% blood transfusions, 5.1% sepsis, 1.3% misoprostol side-effects, and 0.6% re-evacuations.ConclusionSurgical management is the quickest and most effective option followed by medical and expectant management. Complication rates were high, reflecting the inclusion of unstable patients requiring urgent surgical management. Medical and expectant management shouldonly be offered to stable low risk women. Counselling should include the time taken to completed miscarriage and the possible need to change the management method. This allows women to choose a management option best suited to them.

[发布机构] Stellenbosch University