Retrospective cross-sectional study analyzing the effect of introducing non-surgical management of early pregnancy loss

Abstract

Objectives: The incidence of spontaneous abortions is estimated at about 15-20% of all diagnosed pregnancies, of which about 80% occur in the first 12 weeks of pregnancy. Over the last 20 years, views on diagnosis and treatment early pregnancy miscarriage or the finding of an empty pregnancy follicle have evolved. This was possible due to the development of more and more advanced diagnostic techniques (especially ultrasonography), the possibility of quantitative evaluation of B-HCG, the availability of antibiotic therapy as well as the introduction of pharmacological methods of miscarriage induction. The Specialist Hospital of St. Sophia in Warsaw since 2012 has implemented a specialist protocol of treatment in cases missed abortions to reduce the dominance of surgical procedures. The aim of this work is to show and discuss the experiences and effects of changing the trends of surgical and conservative procedures. 

Materials and methods: Retrospective analysis of changes in trends in proceedings in missed abortions at the St. Hospital Sophia in 2010-2017. The study comprised of 3513 patients who reported to the hospital with a miscarriage in the first trimester of pregnancy (up to 13 weeks).

Results: Over the seven year period, there was a total reversal in the proportion of the number of hospitalized women due to early pregnancy loss who underwent surgical treatment. At the same time, the number of patients who underwent conservative and pharmacological management increased. The increase in the frequency of non-surgical management in the event of early pregnancy loss was not associated with an increase in the risk of complications and repeated hospitalizations. The effectiveness of conservative management decreased with the duration of pregnancy

Conclusions: a change in the procedure led to a reduction in the percentage of surgical interventions in relation to conservative and pharmacological procedures. At the same time, the introduced change in standards of management was not associated with an increase of negative consequences in women hospitalized due to early pregnancy loss. Non-surgical management is a safe, effective and consistent with current global guidelines for the treatment of women with early pregnancy loss.

Key words: Early pregnancy loss, Expectant management, Medical management, Surgical management