Routine ultrasound guided evacuation of first trimester missed abortion versus blind evacuation

Abstract

Background: The clinical management of miscarriage has changed little over the years and many women undergo surgical uterine evacuation. Surgical evacuation of the uterine contents in missed abortion is a challenge to the obstetrician as it is done blindly. The current study recommends the use of ultrasound guided surgical evacuation. It serves two important advantages; the first is to complete evacuation without the need of additional step. The second is to protect against uterine perforation. Outcome measures: The primary outcome measures were intraoperative and short-term complications (anesthetic complication, hemorrhage, ongoing pregnancy, cervical trauma, uterine perforation, need for laparoscopy and/or laparotomy, repeat evacuation, and infection). The secondary outcomes were the blood loss, procedure time, and convalescence time. Design: A controlled trial. Setting: Elbadr Hospital, Benha, Egypt. Participants: Women undergoing STOP (surgical termination of pregnancy) in the first trimester. Methods: Two hundred cases who refused medical evacuation of proved missed abortion were divided in two groups. Group one (one hundred patients) in whom surgical evacuation was done under sonographic guidance. Group two (one hundred patients) in whom surgical evacuation was done without sonographic guidance. Results: Group one cases showed no surgical failure in contrast to 10 cases from group two who failed with contents presented after evacuation (failure rate 10%). Conclusions: Surgical evacuation under sonographic guidance is recommended because there are significant cases with missed abortion which can be incompletely evacuated without the use of the ultrasound guidance.

Keywords

• Missed abortion
• Surgical evacuation
• Ultrasound