Comparison of Different Management Strategies for First-Trimester Miscarriages in the Sri Lankan Population

Background: Miscarriage, defined as the spontaneous loss of pregnancy before the fetus reaches viability, is the most common complication in early pregnancy. Traditional surgical evacuation methods, though effective, pose risks such as infection, bleeding, and increased costs. In order to minimize surgical complications, newer treatment strategies like expectant management (watchful waiting) and medical management are introduced. Although these newer methods offer potential benefits, they lack comparative evaluation regarding safety and efficacy, especially in the Sri Lankan context, creating a research gap. Methodology: A cross-sectional analytical study was conducted in teaching hospitals in Sri Lanka, involving 160 women with uncomplicated first-trimester miscarriages divided equally into medical and expectant management groups to compare each management strategy’s success rate and complications. High-risk categories like septic abortions or severe hemorrhage were excluded. The study adopted a non-probability convenient sampling technique. Data were collected using an interviewer-administered data collection form at discharge and 14-day follow-up. Statistical analysis was performed using SPSS, employing chi-square and t-tests to compare success rates and complications. Results: Medical management showed a significantly higher success rate (83.8%) compared to expectant management (62.5%, p < 0.05), achieving complete removal of products of conception. Two groups had significant differences in the period of amenorrhea, degree of products, fetal pole length, and size of gestational sac (p < 0.05). Additional medical treatments, hospital admissions, and PV bleeding were higher in the expectant group compared to the medical group (p < 0.05). Difficulty in micturition (8.8% vs. 1.3%) and fever (7.5% vs. 2.5%) were significantly higher in the medical management group compared to the expectant management group (p < 0.05). Conclusion: Medical management using misoprostol is a highly effective and acceptable alternative to surgical intervention for first-trimester miscarriages in Sri Lanka, outperforming expectant management in success rates and reduced complications. These findings advocate revising clinical guidelines and increasing awareness of non-surgical options to ensure patient-centered, cost-effective care. Further research is recommended to evaluate long-term outcomes and integrate patient preferences into management protocols.