Women's Preferences For Management Options For First Trimester Miscarriage

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In the absence of clear evidence of clinical superiority from randomised controlled trials, the decision about which management option to offer women with a diagnosed first trimester miscarriage should be informed by evidence on cost-effectiveness and women's preferences. To elicit women's preferences for attributes of alternative management options for first trimester miscarriage.

A recent study led by Dr. Stavros Petrou of the University of Oxford entitled "Women's preferences for attributes of first trimester miscarriage management: A stated preference discrete choice experiment", published in Value in Health, elicits women's preferences for attributes of these alternative management options. The study was co-authored by Dr. Emma McIntosh also from the University of Oxford.

Approximately one in nine confirmed early pregnancies end in miscarriage during the first trimester. The traditional approach is to surgically evacuate the retained products of conception. However, surgical management has been associated with a number of complications. Two alternative management options to surgical management, medical management and expectant management (no intervention) have been increasingly offered to women.

Says Dr. Petrou: "The study highlights the importance to women of reducing the levels of pain and the time taken to return to normal activities after treatment. Overall, the study suggested that many women undergoing management of first trimester miscarriage value surgical and medical management more highly than expectant management. These results should be taken into consideration by decision-makers as they consider how best to organise gynaecological services for women experiencing miscarriage."

ABSTRACT

Full article: http://www.medicalnewstoday.com/articles/122971.php

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New book on miscarriages

Photo by www.miscarriagemedicinemiracles.com

In "Miscarriage, Medicine & Miracles: Everything You Need to Know About Miscarriage" (Bantam, $25), author Dr. Bruce K. Young provides comprehensive information on the causes and prevention of miscarriages. A few causes include hormonal deficiencies, fibroids and cervical insufficiency, for which treatments are available. The book also breaks down myths and explores grief as well as coping techniques following a lost pregnancy.

Website: www.miscarriagemedicinemiracles.com/

Google Book Search: http://books.google.com/books?id=WPfaIAAACAAJ&dq=%22Miscarriage,+Medicine+%26+Miracles%22&ei=3_BbSJC4DpTIsQOsgoS_DQ

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Mother speaks of anger over miscarriage blunder

A mum told she had had a miscarriage found that the foetus was still alive four weeks later.

Catherine Kent, 27, was offered an abortion or pills to shorten her miscarriage after medics said her baby had died inside her during the eighth week of pregnancy.

Instead, she left the foetus to leave her body naturally. A month later a further check revealed the unborn child was alive.

Now Catherine and partner Kevin Gray, 28, claim the blunder by Sunderland Royal Hospital could have had tragic consequences.

Mum of two Catherine, of Houghton le Spring, has complained. She said: "It was utter hell.

"They could have aborted my baby while it was alive or the pills could have left it disabled."

The hospital said: "We're investigating."

Source: http://www.mirror.co.uk/news/topstories/2008/02/13/mother-speaks-of-anger-over-miscarriage-blunder-89520-20317670/

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D&C vs. Natural - the effect on fertility

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

Among 114 women with early spontaneous abortions, low beta-human chorionic gonadotropin levels and no ultrasonographically demonstrable residual tissue in the uterine cavity, 68 underwent uterine curettage, and 46 were managed conservatively. No complications, such as bleeding or infection, were observed in either group, and the probability of conception, outcome of subsequent pregnancies and rate of subsequent abortions were similar. Curettage offers no advantage over conservative management in selected patients with early abortions.

PMID: 1774726 [PubMed - indexed for MEDLINE]
Source: http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=1774726