Surgical management

Women undergoing surgical evacuation should be considered for genital tract infection screening (C. trachomatis, Neisseria gonorrhoea or bacterial vaginosis) due to the risk of subsequent pelvic inflammatory disease (1).

Suction curettage is used for the evacuation of the uterine cavity (1) and has less blood loss and pain when compared to sharp curettage (2)

Women who prefer surgical evacuation should be offered surgical uterine evacuation (ERPC).

NICE suggest with respect to surgical management of miscarriage (3)

• where clinically appropriate, offer women undergoing a miscarriage a choice of:
  • manual vacuum aspiration under local anaesthetic in an outpatient or clinic setting
  • or surgical management in a theatre under general anaesthetic

Clinical indications for surgical approach include:

• persistent excessive bleeding
• haemodynamic instability
• evidence of infected retained tissue
• suspected gestational trophoblastic disease (1)

Rare but serious complications of surgery include:

• perforation - 1%
• cervical tears
• intra-abdominal trauma - 0.1%
• intrauterine adhesions
• haemorrhage
• infection
• anaesthetic complications (2)

Reference:

• 1. Royal College of Obstetricians and Gynaecologists (RCOG) 2006. The management of early pregnancy loss
• 2. Sagili H, Divers M. Modern management of miscarriage. The Obstetrician & Gynaecologist 2007;9:2:102-108
• 3. NICE (April 2019).Ectopic pregnancy and miscarriage