Management of first trimester spontaneous abortions

BMJ 1995;310:1426 (3 June)

Editorials

Management of first trimester spontaneous abortions

May be expectant treatment for up to three days in selectedcases

Many procedures in obstetrics and gynaecology are ripe for re-evaluation.On the basis of a recent paper,¹ surgical evacuation of theuterine contents after all miscarriages in the first trimestermay be one of them.

The rationale for curettage as the correct management is basedon a series of cases published when parity, general health,and the incidence of criminal abortion differed greatly fromnow.² Doctors reported infection (due to retained products ofconception after criminal abortion) and bleeding against a backgroundof anaemia, multiparity, and poor nutrition. Although the incidenceof severe adverse events was low, their severity warranted completeevacuation of the uterus. In addition, immediate curettage wasthought to decrease the duration of convalescence and avoidedthe need for routine follow up. All curettings were sent forpathological examination, and procedures were introduced toflag . . . [Full text of this article]