%0 Journal Article
%T Expectant Management of Miscarriage in View of NICE Guideline 154
%A Junaid Rafi
%A Haroona Khalil
%J Journal of Pregnancy
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/824527
%X Objective. To find out the success rate of conservative management of complete two weeks for miscarriage in view of NICE Guideline 154. Design. Prospective observational study. Setting. Early pregnancy assessment units of District General Hospital in the United Kingdom. Participants. Women of less than 14 weeksĄŻ gestation, with a diagnosis of miscarriage (missed miscarriage/anembryonic or incomplete miscarriage). Interventions. Expectant management for two weeks. Main Outcome Measure. (1) Efficacy of 2-week expectant management, that is, complete resolution of miscarriage based either on self-reporting of patient after passing products of conception at home between D0 and D14 of expectant management or confirmation on scan at D14, and (2) short-term complications needing strong analgesia, blood transfusion, and antibiotics. Results. Expectant management of miscarriage for 2 weeks from the day of diagnosis was successful in 58% (64 /111) and failed in 42% (47/111). Conclusions. Expectant management success rate is consistent with the results from the longitudinal studies and RCTs published in the past. It is a safe option as none of the patients on expectant/medical management needed strong analgesia/antibiotics or blood transfusion. 1. Introduction Approximately 11¨C15% [1] of pregnancies result in spontaneous first-trimester miscarriage and for some women, it could be quite traumatic experience physically as well as psychologically. Many women want to get over it and therefore are quite keen on active management; either medical or surgical; however, a sizeable percentage seems keen to explore conservative option of wait-and-see approach. The new NICE 154 Guideline recommends expectant management for 7¨C14 days as the first-line management strategy for miscarriage to explore management options other than expectant management if the woman is at increased risk of haemorrhage and had history of stillbirth, miscarriage, or ante partum haemorrhage in previous pregnancy; for example, a history of stillbirth, miscarriage or ante partum haemorrhage in previous pregnancy; coagulopathies; unable to have a blood transfusion or if there is evidence of infection. We aimed to find out the success rate of conservative management of complete two weeks for miscarriage. 2. Material and Method We conducted this prospective longitudinal study from August 2012 to June 2013 in District General Hospital setting. The NICE Guideline 154 was published in December 2012; however, we started collecting data in our Early Pregnancy Assessment Unit (EPAU) for this study since August
%U http://www.hindawi.com/journals/jp/2014/824527/