Comparison of Medical Vs Surgical Management of Missed Abortion

Abstract

Objective: To compare the outcome of medical vs. surgical management of missed abortion in
terms of success rate and complications
Material and Methods: All the participants were admitted in hospital gynecology ward and
were divided into two groups. 55 women were randomly selected to undergo surgical
management i.e. D&C and 75 women to receive medical treatment with oral misoprostol 400μgm
thrice daily for 2 days.If the patient did not expel products of conception during 48 hours, her
medical management was considered to be failed and surgical evacuation was done. Data
collection was done on a structured Performa which was then entered on excel Data sheet and
analyzed on spss20 statistical package.
Results: Surgical management was successful in 100% cases. Complications were more with
surgical management i.e. nausea, vomiting, postoperative fever, lower abdominal pain,
excessive bleeding, need for blood transfusion and genital tract trauma. Medical management
had a lower success rate, evacuation was sometimes incomplete and patient had to experience
labor pains but it had lower complication rate. D&C was easier in medical management group.
Patient acceptability was more for medical group.
Conclusion: Surgical management has a high success rate but its complications are more as
compared to medical management. Surgical evacuation as first line treatment option is only
suitable for a woman who does not wish to undergo labor discomfort .Medical termination is
easier to manage, more natural, associated with least complications and more acceptable by the
patients but its success rate is slightly less as compared to surgical intervention. Hence each
patient should be given the chance of medical termination for at least two days and if she does not
expel products of conception spontaneously during this time, then only surgical evacuation
should be done