In spontaneous miscarriage, a new study has compared all treatment options for the first time. It appears that the strategy to be chosen must above all be done in agreement with the women.
Faced with a first trimester miscarriage, current medical recommendations generally advise waiting for the embryo to evacuate naturally: this is the natural treatment.
A new analysis, which reviews 46 trials involving more than 9,000 women facing miscarriage, shows that this wait-and-see attitude is only successful in 70% of cases and that, moreover, it can lead to complications which however are rarely reported to patients.
Published in the journal Human Reproduction Updatethese are the results of a comparison made for the first time between all available options for treating a miscarriage, by researchers at the University of Warwick and Queen Mary University, London.
Equivalent efficiency but different constraints
National English (NICE) guidelines recommend wait-and-see symptomatic treatment as the first line of treatment before offering medical or surgical treatment if the miscarriage is not over within two weeks. This study provides evidence of equivalent efficacy of all available options based on a comprehensive review of the literature.
In the event of a miscarriage, the researchers therefore recommend that doctors rather offer women a choice of different treatment options in order to allow them to make an informed decision taking into account of course the effectiveness, but also possible adverse effects, waiting periods and recovery periods which may be extended in certain cases.
A traumatic event
Miscarriage is the most common complication of pregnancy and affects approximately one in four pregnancies. When it is early, it corresponds to the elimination of an abnormal embryo and the doctors prefer not to intervene to preserve the pregnancy at all costs.
A miscarriage, however, can be a traumatic experience for both parents, resulting in feelings of loss and grief that can sometimes lead to depression, and negatively affecting the couple’s ability to regain fertility.
An exhaustive study
The study looked at the treatment options available to women who had a miscarriage before the 14th week of pregnancy, which included symptomatic treatment while awaiting the natural evacuation of the embryo.
During a first trimester miscarriage, the body tries to naturally get rid of a pregnancy that is abnormal, but this process can be painful and come with increased bleeding, increased risk of hospitalization and death. reduced quality of life. Moreover, the study showed that this attitude could lead to complete elimination of the embryo in only 70% of cases.
Equivalence of treatments
Surgery (suction) and medical treatment (chemical treatment) have similar effectiveness in managing miscarriage compared to conservative treatment. Surgical options include vacuum pump aspiration, offered by the majority of English public hospitals, but which requires general anesthesia and a visit to the operating theatre. Manual vacuum aspiration is not yet a common service in these hospitals and requires special training from healthcare professionals. However, since it can be performed under local anesthesia, it is only responsible for a reduced recovery time.
This study shows that there is not much difference in effectiveness between taking a pill or undergoing either surgery. Manual suctioning would even be a better technique for patients, as they go home faster and recover faster. In addition, the latter saves money for the national health system (NHS), because it uses fewer resources.
A shared and informed decision
Even though the wait-and-see symptomatic treatment seems like a natural treatment, it might be responsible for more side effects if compared to taking a pill that can complete the process faster. In the past, research has mostly focused on treatment effectiveness, and few studies have considered other important factors such as post-treatment stress and side effects.
What should now be done is provide women with evidence-based information about the benefits and harms of each treatment option, as well as its potential side effects, so that they can choose the strategy. with which they feel most comfortable.
Some women will be more inclined to have quick surgery in order to get back to their lifestyle immediately, others will be more eager to avoid surgery and prefer to take a pill, and others will want to take a more natural approach.
.
