SPONTANEOUS-ABORTION - A MEDICAL APPROACH TO MANAGEMENT

The conventional management of spontaneous abortion is surgical evacua tion of the uterus to prevent complications which may arise from retai ned products of conception (POC). This procedure is not without compli cations and also demands operating theatre resources. The purpose of t his study was to determine the efficacy of a medical approach to the m anagement of spontaneous abortion using the prostaglandin analogue, ge meprost. From an initial 212 women presenting with spontaneous abortio n, 4 groups were defined according to what they required in the way of initial management. A group of 20 women were excluded from conservati ve medical management at presentation because they were bleeding heavi ly and judged to be unsuitable. Sixty women initially required no furt her management other than determining that they had a complete abortio n using transvaginal sonography (TVS). The 132 women were treated with the prostaglandin analogue, gemeprost. Sixty were judged to need no f urther management afterwards and were initially discharged. The remain ing 72 women underwent evacuation of retained products of conception ( ERPC) after the gemeprost treatment as medical evacuation of the uteru s appeared to had been incomplete. In each of these 4 groups so define d, there was 1 case where an ERPC was required after the patients have been discharged because of complications attributable to retained POC . We therefore found that no ERPC was necessary in the management of 1 18 out of 212 (55.6%) women who presented with spontaneous abortion. T his has important implications in patient management and economical us e of hospital resources.