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 goldstandard 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?
Keywords: analgesia / miscarriage / misoprostol /psychological sequelae
Introduction
Medical management of miscarriage
Mifepristone: is it indicated in miscarriage?
Choice of prostaglandin analogue: gemeprost or misoprostol
Route of misoprostol administration
Mode of action and adverse effects with misoprostol
Medical management of first trimester miscarriage
Medical management of second trimester miscarriage
Conclusion
Medical management of miscarriage is a safe and effective
means of miscarriage. Medical management is an alternative
technique that complements but does not replace surgical
management. Its availability has led to an improvement in
choice for women who miscarry