Wijesinghe P S, Padumadasa G S, Palihawadana T S, Marleen F S
Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
Ceylon Med J. 2011 Mar;56(1):10-3. doi: 10.4038/cmj.v56i1.2888.
Incomplete miscarriage is often treated with surgical evacuation in Sri Lanka. Expectant management, which is an alternative treatment, was assessed for efficacy and safety in a local setting.
Randomised clinical trial of two treatment groups of expectant and surgical management with 71 and 69 participants, respectively, was done at the University Gynaecology Unit of the Colombo North Teaching Hospital, Ragama, from December 2007 to July 2009. Women with incomplete miscarriage at a period of amenorrhoea of < 14 weeks and retained products of conception of < 50mm were included. Expectant management involved in-ward treatment till resolution of heavy bleeding and pain and follow up for two weeks. In surgical treatment, evacuation was undertaken and the patient sent home from hospital after bleeding settled with follow up. The maximum anteroposterior diameter of the endometrial cavity was measured with transvaginal ultrasonography and a diameter < 15mm was considered as complete miscarriage.
Expectant management had a treatment success of 90.1% at one week and 94.4% at two weeks. For surgical treatment this was 95.7%. Infection was noted in one subject from the surgical group and none in the expectant group. Fall in the haemoglobin concentration in the two groups was clinically not significant. The expectantly managed group had a shorter hospital stay than the surgically managed group (1.58 vs 2.57 days, p = 0.008).
Expectant management is an effective and safe alternative to surgical evacuation in management of incomplete miscarriage in the local setting. It relieves the burden on the healthcare provider by shortening the hospital stay and avoiding the need for evacuation of retained products of conception under anaesthesia.
在斯里兰卡，不完全流产通常采用手术清宫治疗。本研究在当地环境中评估了作为替代治疗方法的期待疗法的有效性和安全性。
2007年12月至2009年7月，在拉贾马市科伦坡北部教学医院大学妇科病房进行了一项随机临床试验，将71名和69名参与者分别分为期待治疗组和手术治疗组。纳入闭经时间<14周且妊娠物残留<50mm的不完全流产妇女。期待疗法包括住院治疗直至大出血和疼痛缓解，并进行两周的随访。手术治疗则进行清宫，出血停止后患者出院并进行随访。经阴道超声测量子宫内膜腔的最大前后径，直径<15mm被视为完全流产。
期待疗法在一周时的治疗成功率为90.1%，两周时为94.4%。手术治疗的成功率为95.7%。手术组有1名受试者发生感染，期待组无感染发生。两组血红蛋白浓度的下降在临床上无显著意义。期待治疗组的住院时间比手术治疗组短（1.58天对2.57天，p = 0.008）。
在当地环境中，期待疗法是不完全流产手术清宫的一种有效且安全的替代方法。它通过缩短住院时间并避免在麻醉下清宫，减轻了医疗服务提供者的负担。
