Objective: The aim of our study was to compare and assess the incidence of unplanned uterine curettage between expectant management versus medical and surgical management within of first trimester missed and incomplete miscarriage. Patients and Methods: This Randomized controlled trial included 150 patients diagnosed with early fetal demise at less than 13 weeks’ gestation. They were recruited and assessed for eligibility from Ain Shams University Maternity Hospital. Cases were randomized according to a computer-generated random sequence into three groups; Expectant (A), Surgical (B) and Medical groups (C). the three groups were studied in regard to the incidence of hospital re-admission, gynaecological infection, the duration of clinical symptoms (pain, additional analgesia, vaginal bleeding), complications (fall in haemoglobin at 10-14 days, blood transfusion, unplanned consultations or admissions within 14 days and within eight weeks) and Efficacy.
Results: Our results indicated statistically significant difference (P<0.05) between studied groups as regard vaginal bleeding as a symptom of miscarriage. Regarding the post-intervention bleeding duration per days among the studied groups, our results indicated that bleeding duration was highly significant and the longest among the expectant group followed by the medical then the surgery groups (P<0.001). Our results indicated the presence of statistically significant difference (p-value<0.05) between studied groups as regard failed treatment and shift to surgery that was more prevalent in the expectant group followed by the medical group. Our results indicated no statistical significant difference between studied groups (expectant, medical and surgical groups) as regard emergency unplanned D&C due to heavy bleeding (p-value > 0.05).
Conclusion: The incidence of failed treatment and shift to surgery after expectant, medical and surgical management of spontaneous first trimester miscarriage was more prevalent in the expectant group followed by the medical group then the surgical group. Regarding complications, our results indicated a highly statistical significant difference between studied groups as regard hypotension. It was more prevalent in medical group followed by the expectant group then the surgical group.