Outcomes of treatment for first trimester miscarriage

In this thesis and the related thesis by Marianne Verschoor ‘Management of first trimester miscarriage; new insight in old dilemmas’ we describe the short and long term effects of misoprostol and curettage in the treatment of first trimester miscarriage. The first part describes long term complications of curettage. We conducted two systematic reviews and meta-analyses. The first describes the incidence and risk factors on the formation of intra uterine adhesions (IUA). The risk on IUA increases with the number of miscarriages and number of curettages performed. The second review describes the increased risk of preterm birth in women with a history of curettage, compared to women without such history. The second part describes the management of an incomplete evacuation of the uterus after misoprostol use for first trimester miscarriage. Although women with an incomplete evacuation are often relatively asymptomatic, a curettage is often performed. We conducted a randomized controlled trial, comparing curettage to expectant management. A cohort study was conducted alongside this trial following women who received treatment of their preference. These studies show, that although curettage is slightly more effective, expectant management is safe and also effective in at least 5 out of 6 women. Quality of life did not differ between randomized women, and in the cohort, women who underwent expectant management reported a slightly better quality of life. Furthermore, curettage does not seem cost effective over expectant management in women with an incomplete evacuation. In these studies we found no differences in subsequent pregnancy rates or pregnancy outcomes