Management

The goal of management of early miscarriage is assurance of complete emptying of the uterus in the least traumatic manner, avoidance of excessive blood loss, prevention of infection, and administration of adequate emotional support. Women with threatened abortions are reassured somewhat that the loss is neither imminent nor inevitable. Bed rest is encouraged, but no evidence supports its value in prevention of miscarriage.

When there is profuse bleeding or sepsis, women with inevitable, incomplete, or septic abortions require prompt surgical treatment in the form of dilation and curettage (D&C), or in some, curettage alone. IV antibiotics should be used when appropriate. Rarely, blood transfusion is required. Certain women may benefit from oral antibiotics and methylergono-vine (Methergine) on discharge.

When the diagnosis is missed abortion or incomplete abortion without hemorrhage or infection, the choice is surgical intervention versus natural spontaneous completion of the miscarriage. In well-selected women, no convincing evidence suggests one method is preferable. Many practitioners give these patients the option of D&C or spontaneous resolution. D&C has risks of anesthesia, cervical trauma, uterine scarring, and perforation; spontaneous resolution has risks of infection and hemorrhage. If products of conception for karyotype analysis are required for the evaluation of recurrent losses, surgical approach is more successful in producing uncontaminated tissue for culture.

Those women who are Rh(D)-negative and less than 13 weeks' gestation should receive 50 ^.g of D immune globulin intramuscularly when the abortion is diagnosed, to prevent sensitization. If beyond 13 weeks, 300 ^.g is used.

This treatment can be omitted if the father is known to be D-negative as well. Iron therapy should be given to women when heavy bleeding occurs or is anticipated.

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