Comparison between Medical and Surgical Treatment of Incomplete First Trimester Abortion

Introduction: Women with an incomplete, inevitable, or missed abortion predictable by ultrasound imaging, can be controlled, medically, surgically or expectantly. Using of medical and surgical treatments were satisfactorily effective and safe, and tolerable to women. Patients treated with medication and still complaining from extreme bleeding are advised to admitted to the emergency department. Aim of the work: To evaluate medical and surgical methods for controlling of incomplete abortion at first trimester. Patients and Methods: The investigation is a prospective comparative study was conducted in Al-Azhar University Hospitals clinic between June 2018 and June 2019. Three hundred patient were diagnosed as the first-trimester incomplete miscarriage and randomly divided into three groups each group included one hundred patients. Group I (surgical management): they underwent Evacuation & Curettage (E & C). Group II (medical management) (Misoprostol group): they received oral Misoprostol of 200 mcg on six hourly intervals for a maximum of forty eight hours duration. Group III (expectant management): just for observation and no treatment. All patients were followed up after 1 week with a transvaginal ultrasonography. Results: In this study, Success rate was 96%, 90%, 80% in groups I, II and III, respectively, failed treatment was in 4 patients in surgical group and need re-evacuation, in 10 patients in Misoprostol group and in 20 patients in expectant group and need surgical management. The difference in failure rate between the studied groups was statistically significant. As regards complications There were statistically a high significant difference between the three studied groups regarding excessive bleeding (1%, 6% and 15% in groups I, II and III, respectively). Regarding re-evacuation a significant difference (4%, 10% and 20% in groups I, II and III, respectively) was recorded, also, a non-significant differences regarding perforation (only 1 patient in group I) and foul smelling and vaginal discharge (only 1 patient in group III). As regards patient satisfaction, Satisfaction was 85%, 95% and 80% in groups I, II and III, respectively, a statistically there were a significant variation between the three studied groups regarding patient satisfaction. Conclusion: Misoprostol is found to be as effective as surgical treatment in the treatment of incomplete miscarriage, at a single dose of 200 mcg, with complete evacuation of uterus in most women, and the side effects can be tolerated by all patients. Patients who didn’t want to stay in the hospitals are highly pleased with the misoprostol therapy. The volume of bleeding was more or less comparable to the menstrual bleeding which didn't impact the daily tasks of the women. The medical therapy is an efficient tool like a surgical interference and the patient satisfaction is more higher than the surgical evacuation. [Amr M. Abdulmajeed, Hossam E. Hussein, El Sayed Eldesouky and Elsayed Farag. Comparison between Medical and Surgical Treatment of Incomplete First Trimester Abortion. Life Sci J 2019;16(8):1-10]. ISSN: 1097-8135 (Print) / ISSN: 2372-613X (Online). http://www.lifesciencesite. com. 1. doi:10.7537/marslsj160819.01.