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Ultrasound Diagnosis and Management of Miscarriage

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Abstract

Miscarriage is known to occur in at least 10-20% of clinical pregnancies.1 The majority occur before the 13th week. The risk of miscarriage is reduced to 3% if a viable embryo has been seen by ultrasonography. In recent years, early pregnancy units have been introduced in order to improve the efficiency of dealing with women with early pregnancy loss.2 Management of these women has since changed in many units, with a shift away from a surgical approach to one based on an expectant or “watch and wait” policy.3 Despite this, in the UK the majority of women with miscarriage are referred to a hospital for assessment and 88% currently undergo surgical evacuation of retained products. The assumption has been that retained products of conception increase the risks of infection and haemorrhage. In fact, less than 10% of women who miscarry experience excessive vaginal bleeding or have infected products of conception within the uterine cavity. In a randomised study, Neilson et al. showed that there was no increased risk of complications for women who underwent expectant management of incomplete miscarriage compared to a surgical approach.4 The use of non-surgical approaches to the management of miscarriage seems logical

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References

  1. Alberman E (1992) Spontaneous abortion: epidemiology. SpringerVerlag, London, pp 9–20

    Google Scholar 

  2. Bigrigg MA, Read MD (1991) Management of women referred to early pregnancy assessment unit: care and cost effectiveness. Br Med J 302:577–579

    Article  CAS  Google Scholar 

  3. Hemminki E (1998) Treatment of miscarriage: current practice and rationale. Obstet Gynecol 91:247–253

    Article  PubMed  CAS  Google Scholar 

  4. Neilsen S, Hahlin M (1995) Expectant management of first trimester spontaneous abortion. Lancet 345:84–86

    Article  Google Scholar 

  5. Warren WB, Timor-Tritsch IE, Peisner DB et al. (1989) Dating the early pregnancy by sequential appearance of embryonic structures. Am J Obstet Gynecol 161:747–753

    PubMed  CAS  Google Scholar 

  6. Luise C, Jermy K, Collins WP et al. (2002) Outcome of expectant management of spontaneous first trimester miscarriage: observational study. Br Med J 324:873–875

    Article  Google Scholar 

  7. Levi CS, Lyons EA, Zheng XH et al. (1990) Endovaginal ultrasound: demonstration of cardiac activity in embryos less than 5.0mm in crown-rump length. Radiology 176:71–74

    PubMed  CAS  Google Scholar 

  8. Marinez JM, Comas C, Ojuel J et al. (1996) Fetal heart rate patterns in pregnancies with chromosomal disorders or subsequent fetal loss. Obstet Gynecol 87:118–121

    Article  Google Scholar 

  9. Jurkovic D, Ross JA, Nicolaides KH (1998) Expectant management of missed miscarriage. Br J Obstet Gynaecol 105:670–671

    Article  PubMed  CAS  Google Scholar 

  10. Hurd WW, Whitfield RR, Randolph JF Jr et al. (1997) Expectant management versus elective curettage for the treatment of spontaneous abortion. Fértil Steril 68:601–606

    Article  PubMed  CAS  Google Scholar 

  11. Nielsen S, Hahlin M, Moller A et al. (1996) Bereavement, grieving and psychological morbidity after first trimester spontaneous abortion: comparing expectant management with surgical evacuation. Hum Reprod 11:1767–1770

    PubMed  CAS  Google Scholar 

  12. Luise C, Jermy K, Collins WP et al. (2002) Expectant management of incomplete, spontaneous first trimester miscarriage: outcome according to initial ultrasound criteria and value of follow-up visits. Ultrasound Obstet Gynecol 19:580–582

    Article  PubMed  CAS  Google Scholar 

  13. Schwarzler P, Holden D, Nielsen S et al. (1999) The conservative management of first trimester miscarriages and the use of colour Doppler sonography for patient selection. Hum Reprod 14:1341–1345

    Article  PubMed  CAS  Google Scholar 

  14. Neilsen S, Hahlin M, Platz-Christensen J (1999) Randomised trial comparing expectant with medical management for first trimester miscarriages. Br J Obstet Gynaecol 106:804–807

    Article  Google Scholar 

  15. Hinshaw HKS (1997) Medical management of miscarriage. Problems in early pregnancy: advances in diagnosis and management. RCOG Press, London, pp 284–295

    Google Scholar 

  16. el-Refaey H, Hinshaw K, Henshaw R et al. (1992) Medical management of missed abortion and anembryonic pregnancy. Br Med J 305:1399

    Article  CAS  Google Scholar 

  17. Henshaw RC, Cooper K, el-Refaey H et al. (1993) Medical management of miscarriage: non-surgical uterine evacuation of incomplete and inevitable spontaneous abortion. Br Med J 306:894–895

    Article  CAS  Google Scholar 

  18. Chung TK, Cheung LP, Lau WC et al. (1994) Spontaneous abortion: a medical approach to management. Aust NZ J Obstet Gynaecol 34:432–436

    Article  CAS  Google Scholar 

  19. de Jonge ET, Makin JD, Manefeldt E et al. (1995) Randomised clinical trial of medical evacuation and surgical curettage for incomplete miscarriage. Br Med J 311:662

    Google Scholar 

  20. Chung TK, Cheung LP, Leung TY et al. (1995) Misoprostol in the management of spontaneous abortion. Br J Obstet Gynaecol 102:832–835

    Article  PubMed  CAS  Google Scholar 

  21. Nielsen S, Hahlin M, Platz-Christensen J (1997) Unsuccessful treatment of missed abortion with a combination of an antiprogesterone and a prostaglandin El analogue. Br J Obstet Gynaecol 104:1094–1096

    Article  PubMed  CAS  Google Scholar 

  22. Johnson N, Priestnall M, Marsay T et al. (1997) A randomised trial evaluating pain and bleeding after a first trimester miscarriage treated surgically or medically. Eur J Obstet Gynecol Reprod Biol 72:213–215

    Article  PubMed  CAS  Google Scholar 

  23. Jurkovic D (1998) Editorial: Modern management of miscarriage: is there a place for non-surgical treatment? Ultrasound Obstet Gynecol 11:161–163

    Article  PubMed  CAS  Google Scholar 

  24. Chipchase J, James D (1997) Randomised trial of expectant versus surgical management of spontaneous miscarriage. Br J Obstet Gynaecol 104:840–841

    Article  PubMed  CAS  Google Scholar 

  25. Blohm F, Hahlin M, Nielsen S et al. (1997) Fertility after a randomised trial of spontaneous abortion managed by surgical evacuation or expectant treatment. Lancet 349:995

    Article  PubMed  CAS  Google Scholar 

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© 2003 Springer-Verlag London Limited

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Condous, G., Okaro, E., Bourne, T. (2003). Ultrasound Diagnosis and Management of Miscarriage. In: Ultrasound and Endoscopic Surgery in Obstetrics and Gynaecology. Springer, London. https://doi.org/10.1007/978-1-4471-0655-5_35

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  • DOI: https://doi.org/10.1007/978-1-4471-0655-5_35

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-1170-2

  • Online ISBN: 978-1-4471-0655-5

  • eBook Packages: Springer Book Archive

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