5-year review of the medical management of miscarriage at the Aberdeen Maternity Hospital (AMH)

Andrea Woolner, Lena Crichton

Research output: Contribution to journalAbstract

Abstract

Aims . This audit aimed to evaluate outcomes following medical management of miscarriage using the current local Aberdeen Maternity Hospital (AMH) guideline. It was hoped this audit would determine new standards of practice and review current practice, given the recently updated recommendations from the National Institute of Clinical Excellence (NICE).

Methods. A retrospective audit was carried out using the NHS Grampian Rubislaw database. All women diagnosed with early fetal demise (EFD) or incomplete miscarriage between September 2007 and January 2013 were included. A total of 2,220 women diagnosed with EFD and 430 women with incomplete miscarriage were included.

Results . Many women with EFD (926, 41.7%) and the majority of women with incomplete miscarriage (272, 63.3%) selected medical management. Most women required a total dose of 1,200 μ g of misoprostol in divided doses for both EFD and incomplete miscarriage. Few women required inpatient stay with EFD, and the median length of stay for incomplete miscarriage was 1 night. Side-effects and complications were low for both groups of women. Women who were para 0 appeared to require a greater number of doses of misoprostol than parous women with EFD (p 0.04) but this was not found for women treated for incomplete miscarriage ( p 0.35).

Conclusion. Given the growing evidence to suggest increased effectiveness of vaginal misoprostol, new local guidance should reflect the NICE recommended introduction of vaginal misoprostol in a single dose of 800 μ g for both EFD and incomplete miscarriage (600 μ g). Further audit is required to evaluate changes to local guidance. Improvements could be made to the Rubislaw database and the data input for this useful resource.
Original languageEnglish
Pages (from-to)918
Number of pages1
JournalJournal of Obstetrics and Gynaecology
Volume33
Issue number8
DOIs
Publication statusPublished - Nov 2013

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Maternity Hospitals
Spontaneous Abortion
Fetal Death
Misoprostol
Databases
Inpatients
Length of Stay
Guidelines

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5-year review of the medical management of miscarriage at the Aberdeen Maternity Hospital (AMH). / Woolner, Andrea; Crichton, Lena.

In: Journal of Obstetrics and Gynaecology, Vol. 33, No. 8, 11.2013, p. 918.

Research output: Contribution to journalAbstract

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abstract = "Aims . This audit aimed to evaluate outcomes following medical management of miscarriage using the current local Aberdeen Maternity Hospital (AMH) guideline. It was hoped this audit would determine new standards of practice and review current practice, given the recently updated recommendations from the National Institute of Clinical Excellence (NICE). Methods. A retrospective audit was carried out using the NHS Grampian Rubislaw database. All women diagnosed with early fetal demise (EFD) or incomplete miscarriage between September 2007 and January 2013 were included. A total of 2,220 women diagnosed with EFD and 430 women with incomplete miscarriage were included. Results . Many women with EFD (926, 41.7{\%}) and the majority of women with incomplete miscarriage (272, 63.3{\%}) selected medical management. Most women required a total dose of 1,200 μ g of misoprostol in divided doses for both EFD and incomplete miscarriage. Few women required inpatient stay with EFD, and the median length of stay for incomplete miscarriage was 1 night. Side-effects and complications were low for both groups of women. Women who were para 0 appeared to require a greater number of doses of misoprostol than parous women with EFD (p 0.04) but this was not found for women treated for incomplete miscarriage ( p 0.35). Conclusion. Given the growing evidence to suggest increased effectiveness of vaginal misoprostol, new local guidance should reflect the NICE recommended introduction of vaginal misoprostol in a single dose of 800 μ g for both EFD and incomplete miscarriage (600 μ g). Further audit is required to evaluate changes to local guidance. Improvements could be made to the Rubislaw database and the data input for this useful resource.",
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