Kong Grace Wing Shan, Lok Ingrid Hung, Yiu Alice Ka Wah, Hui Annie Shuk Yi, Lai Beatrice Pui Yee, Chung Tony Kwok Hung
Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
Aust N Z J Obstet Gynaecol. 2013 Apr;53(2):170-7. doi: 10.1111/ajo.12064. Epub 2013 Mar 13.
The management of first-trimester miscarriage has been studied extensively in recent years. However, relatively little attention has been focussed on woman's satisfaction and psychological impact from different treatment modalities.
To investigate the clinical and psychological outcomes of surgical, medical and expectant management of first-trimester miscarriage.
A prospective randomised controlled trial of 180 women suffering miscarriage managed by either surgical evacuation, medical evacuation or expectant management was conducted in a university-affiliated, tertiary referral hospital. The complete miscarriage rate, clinical symptomatology, complications, women's satisfaction and the psychological impact were evaluated.
Women in surgical evacuation (98.1%) had a significantly higher complete miscarriage rate when compared with medical evacuation (70%) and expectant management (79.3%). Women who had surgical evacuation had significantly shorter duration of vaginal bleeding, but higher rate of infection. Women who had medical evacuation had significantly more gastrointestinal symptoms. Despite differences in efficacy and complication profile, there was no significant difference in satisfaction among groups. There were no significant differences in terms of psychological well-being, depression scores, anxiety level, fatigue symptoms as measured in General Health Questionnaire-12, Beck Depression Inventory, Spielberger's State Anxiety Inventory and fatigue scale at treatment and four weeks after treatment. However, women with active intervention had greater post-traumatic stress symptoms as measured in Chinese version of Impact of Event Scale-Revised at the time of treatment when compared with women in expectant management.
Without substantial differences in the clinical and psychological impact between different treatment modalities, a more conservative approach with expectant management for miscarriage may be an option for women.
近年来，早孕期流产的管理已得到广泛研究。然而，相对较少的关注集中在不同治疗方式对女性满意度和心理影响方面。
探讨早孕期流产手术治疗、药物治疗和期待治疗的临床及心理结局。
在一所大学附属的三级转诊医院对180例流产女性进行了一项前瞻性随机对照试验，这些女性分别接受手术清宫、药物流产或期待治疗。评估了完全流产率、临床症状、并发症、女性满意度及心理影响。
与药物流产组（70%）和期待治疗组（79.3%）相比，手术清宫组女性的完全流产率显著更高（98.1%）。接受手术清宫的女性阴道出血持续时间显著更短，但感染率更高。接受药物流产的女性胃肠道症状显著更多。尽管在疗效和并发症方面存在差异，但各组之间的满意度无显著差异。在治疗时及治疗后四周，通过一般健康问卷-12、贝克抑郁量表、斯皮尔伯格状态焦虑量表和疲劳量表测量的心理健康、抑郁评分、焦虑水平、疲劳症状方面均无显著差异。然而，与期待治疗组女性相比，在治疗时通过中文版事件影响量表修订版测量，积极干预组的女性创伤后应激症状更严重。
不同治疗方式在临床和心理影响方面无实质性差异，对流产采用更保守的期待治疗方法可能是女性的一种选择。
