Browsing by Author "Marleen, F.S."

Filter results by typing the first few letters
Now showing 1 - 2 of 2
  • No Thumbnail Available
    Item
    Surgical vs expectant Management in incomplete miscarriage: a randomised comparison
    (Sri Lanka College of Obstetricians and Gynaecologists, 2007) Marleen, F.S.; Wijesinghe, P.S.; Palihawadana, T.S.
    INTRODUCTION: Incomplete miscarriage is a common presentation in gynaecology. Surgical evacuation has been the cornerstone of management and an estimated 88% still undergo such interventions worldwide. Due to its risk of complications as well as the heavy financial burden on the health system, expectant management is suggested as an alternate management option in some selected patients. OBJECTIVE: To compare the efficacy and the safety of surgical and expectant management of incomplete miscarriage. METHOD: Study included 105 consecutive women presenting with incomplete miscarriage with a POA less than 14 weeks and was carried out at the university gynaecology unit, North Colombo teaching hospital, Ragama from August 2005 to May 2006. Fifty' one subjects received surgical evacuation while 54 underwent expectant management by random allocation. Surgical evacuation was carried out within 24 hours of ultrasound evaluation and a repeat scan was performed 24 hours after the procedure. The expectant group received inward treatment till bleeding settled and was followed up weekly as out¬patients to confirm complete expulsion. RESULTS: The mean age, POA, duration of bleeding and the haemoglobin level were similar in the two groups. The mean (SD) AP diameter of the retained products was 18.37(4.91) mm and 16.64(1.64), (P>0.05), in the surgical and expectant groups, respectively. A complete evacuation was achieved in all subjects in the surgical evacuation group as confirmed by ultrasound the following day. In the expectant group one subject required an emergency evacuation due to excessive bleeding. Complete expulsion was achieved in 85.1% (n-46) after one week and in 96.2% (n=52) after two weeks. No significant difference was observed in the mean change of haemoglobin level between the two groups. In the surgical group one subject required blood transfusion while another require a laparotomy following uterine perforation. Sepsis was not detected in any subject. The duration of hospital stay was significantly reduced in the expentant group with a mean (SD) stay of 1.5 days compared to 2.4 in the surgical group (p< 0.0001). CONCLUSION: In complete miscarriage with reduced amounts of retained products, expectant management is an option that could be offered. Expectant management up to 1 week will avert surgical intervention in 85% and up to 2 weeks in 96% of patients without an increased risk of complications. The decreased duration of hospital stay will be beneficial for both women as well as the health care providers.
  • No Thumbnail Available
    Item
    A Trial of expectant management in incomplete miscarriage
    (Sri Lanka Medical Association, 2011) Wijesinghe, P.S.; Padumadasa, G.S.; Palihawadana, T.S.; Marleen, F.S.
    INTRODUCTION Incomplete miscarriage is often treated with surgical evacuation in Sri Lanka. Expectant management, which is an alternative treatment, was assessed for efficacy and safety in a local setting. METHODS Randomised clinical trial of two treatment groups of expectant and surgical management with 71 and 69 participants, respectively, was done at the University Gynaecology Unit of the Colombo North Teaching Hospital, Ragama, from December 2007 to July 2009. Women with incomplete miscarriage at a period of amenorrhoea of <14 weeks and retained products of conception of <50mm were included. Expectant management involved in-ward treatment till resolution of heavy bleeding and pain and follow up for two weeks. In surgical treatment, evacuation was undertaken and the patient sent home from hospital after bleeding settled with follow up. The maximum anteroposterior diameter of the endometrial cavity was measured with transvaginal ultrasonography and a diameter <15mm was considered as complete miscarriage. RESULTS Expectant management had a treatment success of 90.1% at one week and 94.4% at two weeks. For surgical treatment this was 95.7%. Infection was noted in one subject from the surgical group and none in the expectant group. Fall in the haemoglobin concentration in the two groups was clinically not significant. The expectantly managed group had a shorter hospital stay than the surgically managed group (1.58 vs 2.57 days, p=0.008). CONCLUSIONS Expectant management is an effective and safe alternative to surgical evacuation in management of incomplete miscarriage in the local setting. It relieves the burden on the healthcare provider by shortening the hospital stay and avoiding the need for evacuation of retained products of conception under anaesthesia.