EXPECTANT MANAGEMENT VERSUS ELECTIVE CURETTAGE FOR THE TREATMENT OF SPONTANEOUS-ABORTION

Objective: To determine whether the amount of intrauterine tissue was prognostic of the risk of complications associated with the management of nonviable pregnancies diagnosed in the first trimester before cerv ical dilatation (termed here impending abortion) with either expectant ; observation or elective curettage. Design: Historic cohort study. Se tting: University Infertility Service. Patient(s): All women with nonv iable pregnancies followed by the Division of Reproductive Endocrinolo gy during a 5-year period. The patients were divided into those with s ignificant intrauterine tissue (gestational sac >10 mm) and those with minimal intrauterine tissue. Intervention(s): Women either underwent elective curettage or were followed expectantly. Main Outcome Measure( s): Complication rates. Result(s): In 89 women with minimal tissue, no complications occurred regardless of treatment mode. In 63 women with significant intrauterine tissue, expectant management resulted in mor e complications (9/24) than elective curettage (1/39). In the expectan t group, complications included missed abortion, septic abortion, and incomplete abortion requiring emergency curettage, with one patient re quiring a transfusion. In the curettage group one uterine perforation occurred. Conclusion(s): In women with impending abortions and minimal intrauterine tissue, expectant treatment is safe after ectopic pregna ncy has been excluded. In patients with significant intrauterine tissu e, the risk of complications may be decreased by elective uterine cure ttage compared with expectant management. (C) 1997 by American Society for Reproductive Medicine.