Managing spontaneous first trimester miscarriage

Clinical review p 1343 Spontaneous miscarriage (inevitable or incomplete) and early fetal demise (previously called missed abortion)1 are components of pregnancy loss in the first trimester. For most of the 20th century spontaneous miscarriage was managed by evacuation of retained products of conception. Traditionally carried out with ovum forceps and curettage, this method changed to vacuum aspiration after advances were made in the equipment to deal with surgical termination of pregnancy. The belief that retained products always needed to be evacuated after spontaneous miscarriage developed because of the two major complications of inappropriately managed miscarriage, bleeding, and infection. However, changes in public health and medical practice have led to questioning of this dogma. Do all women really need evacuation of retained products? And if not, how can we decide who does require it? How likely are complications to arise if evacuation is undertaken—or if it is not? In their review article in this week's BMJ Ankum et al describe the results of a literature search on managing spontaneous miscarriage.2 They propose …