Expectant versus Surgical Management of Early Pregnancy Miscarriage: A Systematic Review

Abstract

Introduction: The management of first-trimester miscarriage can be expectant, medical, or surgical. This review compares the efficacy and safety of expectant management versus surgical management (dilation and curettage).

Methods: A search of the Cochrane Library and MEDLINE was conducted for RCTs comparing expectant management to surgical evacuation for first-trimester miscarriage. The primary outcome was complete uterine evacuation without the need for unplanned surgical intervention.

Results: The meta-analysis of several RCTs showed that surgical management was significantly more effective in achieving complete uterine evacuation in a timely manner. Expectant management had a higher rate of failure requiring unplanned surgical intervention. However, surgical management was associated with a small risk of uterine perforation and infection.

Discussion: While expectant management can be successful for many women and avoids the risks of surgery and anesthesia, it is less predictable and has a higher failure rate. Surgical management offers a definitive and efficient treatment. The choice should be based on a shared decision-making process.

Conclusion: Surgical management is more effective than expectant management for achieving complete evacuation in early pregnancy miscarriage, but expectant management is a reasonable option for many women.