Expectant Versus Surgical Management of First Trimester Miscarriage regarding to Change in Packed Cell Volume and White Blood Cell Count

Introduction: The aim of this study is to compare the efficacy and safety of expectant management with surgical management of first trimester miscarriage. Methods: This randomized prospective study was conducted in the gynecology department at Prince Ali Bin Al-Hussein hospital, Jordan between February 2016 and April 2017. A total of 234 women were recruited following diagnosis of first trimester incomplete or missed miscarriage and randomised into two groups: 109 women were randomised to expectant management (group), and 125 women to surgical management (group). All women were examined clinically and sonographically during the follow-up appointments at weekly intervals for up to four weeks as appropriate. The outcome measures were: efficacy, short term complications and duration of vaginal bleeding and pain. Results: Of 234 eligible women, 17 were lost to follow-up, and the remaining 217 women were analysed. The base line characteristics were similar in both groups. The total success rate at four weeks was lower for expectant than for surgical management (81.4 % vs 95.7 %; P=0.0029). The type of miscarriage was a significant factor affecting the success rate. For missed miscarriage, the success rates for expectant versus surgical management were (75 %) and (93.8 %) respectively. For women with incomplete miscarriage, the rates were (90.5 %) and (98 %). No differences were found in the number of emergency curettages between the two study groups. The duration of bleeding was significantly more in the expectant than the surgical management (mean 11 days vs 7 days; P0.0001). The duration of pain was also more in the expectant than the surgical group (mean 8.1 days vs 5.5 days; P0.0001). The total complication rates were similar in both groups ( expectant 5.9 % vs surgical group 6.1 %; P=0.2479). However, the pelvic infection was significantly lower in the expectant than the surgical group (1.9 % vs 3.5 % respectively; P=0.0146). Conclusion: Expectant management of clinically stable women with first trimester miscarriage is safe and effective and avoids the need for surgery and the subsequent risk of anaesthesia in about 81.4 % of cases, and has lower pelvic infection rate than surgical curettage.