Medical management of miscarriage

Abstract

Key content Miscarriage is a common event in women of reproductive age, with an incidence of 10–20%. Traditionally, surgical evacuation of the uterus was the gold standard for the management of miscarriage. Medical management of miscarriage using a suitable prostaglandin analogue is a safe and effective alternative with high efficacy and patient acceptability. Medical management can be routinely offered as an alternative option, thereby increasing women's choice. Learning objectives To understand the indications, efficacy and adverse effects of medical treatment. To learn about the various treatment regimens of medical management for different types of miscarriage at varying gestations. To understand the need for analgesia and psychological support during treatment. Ethical issues Prescribing misoprostol for unlicensed indication: where do we stand? Can medical management be offered to women where geographical barriers exist? Given the analgesia requirement and psychological sequelae associated with pregnancy loss, is medical management at home a feasible option?