Elsevier

Obstetrics & Gynecology

Volume 91, Issue 2, February 1998, Pages 247-253
Obstetrics & Gynecology

Original Articles
Treatment of Miscarriage: Current Practice and Rationale

https://doi.org/10.1016/S0029-7844(97)00606-6Get rights and content

Abstract

Objective: To describe health service use during miscarriage and medical treatment of miscarriage in Finland and the rationales behind them.

Methods: Description of the treatment practices was based on a survey sent to a nationally representative sample of 3000 Finnish women age 18–44 years in 1994, on national hospital care register data from 1988 and 1995, and on treatment recommendations in textbooks (from 1950–1994) for physicians, nurses, and midwives. Published, controlled studies that were identified through various systematic searches were reviewed for scientific evidence justifying the identified practices.

Results: According to the survey, 97% of the 326 women who had a miscarriage had visited a physician, and 74% were treated as inpatients. The hospital registers indicated that most (at least 84% in 1988, and 88% in 1995) women who had a miscarriage had their uteri evacuated operatively. According to the textbook recommendation, care by a physician, inpatient care, and routine uterine evacuations were seen as norms. No controlled studies providing empirical support for these practices were found. In general, studies were few and recent, and they placed emphasis on different evacuation methods.

Conclusion: Current treatment of miscarriage is not based on controlled studies. All aspects of care, from best care provider to various interventions, urgently need further evaluation by trials.

Section snippets

Materials and Methods

The data sources used in this study defined miscarriage varyingly, but in older literature, it usually meant an intrauterine pregnancy ending unintentionally in a loss before 28 weeks, and in the newer literature, it referred to a loss before 22 weeks. The following subgroups defined by Chamberlain[2]were identified whenever possible: inevitable miscarriage, both complete (all conceptional material is discharged spontaneously) and incomplete (evacuation has started or part of the material is

Treatment Practices

In the 1994 national survey, 326 of 2189 women (15%) reported that they had had one or more miscarriages. Table 1 shows the highest level of health care they had received, according to the year of the (latest) miscarriage. In all years, even when inspected by 5-year intervals, inpatient treatment was dominant, but in recent years, it has been somewhat rarer. Also, outpatient care was given more commonly in hospitals than in physicians’ offices outside hospitals. Only five (1.5%) women had not

Discussion

The different sources used in this study showed that in recent decades, the Finnish norm for treating miscarriage has been routine evacuation of the uterus in a hospital, regardless of the type of miscarriage. The need for professional care apparently has been self-evident for very long, because treatment recommendations did not mention it explicitly. The place of care is now changing from hospital wards to hospital outpatient care, and length of hospital stay is decreasing. It is unclear how

References (27)

  • JL Breen et al.

    Aggressive management of incomplete abortion

    Gen Practitioner

    (1967)
  • G Ben-Baruch et al.

    Curettage vs. nonsurgical management in women with early spontaneous abortions, the effect on fertility

    J Reprod Med

    (1991)
  • S Nielsen et al.

    Expectant management of first-trimester spontaneous abortion

    Lancet

    (1995)
  • Cited by (93)

    • Management of early pregnancy loss, with a focus on patient centered care

      2019, Seminars in Perinatology
      Citation Excerpt :

      For this reason, it is essential that clinician's discus future pregnancy plans, while offering education about and access to contraception or preconception care based on the woman's needs and goals. Depending on the clinical context, available resources, and operator experience clinicians do not consistently offer women the full range of treatment options for the management of EPL.58,59–61 The American Academy of Family Physicians have published guidelines that state office-based aspiration and medical management are safe and effective options for the treatment of EPL.17

    • Miscarriage and mental health: Results of two population-based studies

      2013, Psychiatry Research
      Citation Excerpt :

      Therefore, miscarriage was not defined on the basis of a clinical assessment/record. However, the questions used to assess the history of miscarriage were consistent through the two surveys; moreover, the majority of women who experience a miscarriage in Finland do visit a physician and/or are treated in hospital (Hemminki, 1998): we would therefore assume that a significant proportion of the respondents were likely to have received a clinical diagnosis of miscarriage. Similarly, quality of mood and psychological well-being were assessed through self-reported questionnaires.

    • Mifepristone and misoprostol for early pregnancy failure: A cohort analysis

      2011, American Journal of Obstetrics and Gynecology
    View all citing articles on Scopus
    View full text