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Medical Management of First Trimester Silent Miscarriage

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					Coordinating Committee in Obstetrics & Gynaecology     Medical Management of First Trimester
                                                        Silent Miscarriage(稽留流產藥物治療)
Effective date: 30 May 2008                           Document no.: PILIC0102E version1.0
Version 1.0                                                                      Page 1 of 2

           Medical Management of First Trimester Silent Miscarriage


Indication
Retained product of gestation

The Procedure
  Insertion of vaginal tablets every 3 hours for a maximum of 3 doses for 1 day
  Food or drink will not be allowed when increased abdominal pain occurs
  Pain-killers can be provided
  Vaginal bleeding and abdominal pain can occur prior to passage of uterine content
  The miscarriage process may take more than one day but you can be discharged
  after drug administration
  About 80% of women do not require any surgical procedure to empty the womb.
  Suction evacuation may be required in case of failure to miscarry or incomplete
  miscarriage with heavy bleeding and / or severe pain (local anaesthesia +
  conscious sedation / general anesthesia)
  All tissue removed will be sent to the department of pathology or disposed of as
  appropriate unless otherwise specified
  Other associated procedures:

   - Surgical evacuation (local anaesthesia + conscious sedation / general anesthesia)
   (in case of incomplete miscarriage with heavy vaginal bleeding or severe
   abdominal pain)

Possible Risk and Complication
  Side effects of the drugs including nausea, vomiting, diarrhoea, abdominal pain,
  fever and chills, anaphylaxis
  No response to medication
  Incomplete miscarriage
  Excessive bleeding which may need blood transfusion
  Pelvic infection and the associated adverse effect on future fertility
  Complication of surgical evacuation (in case of incomplete miscarriage with heavy
  bleeding and/or abdominal pain; or no response to medications)
  - Anaesthetic complications, cervical tear, incomplete evacuation, excessive
    bleeding which may need blood transfusion, uterine perforation with or without
    trauma to other organs necessitating laparoscopy / laparotomy, pelvic infection
    and the associated adverse effect on fertility, intrauterine adhesions, cervical
    incompetence, third stage complications in future pregnancy

Risk of Not Having the Procedure
May need surgical evacuation to empty the womb

After the Procedure
  May experience some vaginal bleeding and abdominal cramp within 2-3 weeks
Coordinating Committee in Obstetrics & Gynaecology     Medical Management of First Trimester
                                                        Silent Miscarriage(稽留流產藥物治療)
Effective date: 30 May 2008                           Document no.: PILIC0102E version1.0
Version 1.0                                                                      Page 2 of 2

Alternative Treatment
   Surgical evacuation

Follow Up
  Please consult doctor in case of heavy vaginal bleeding and / or severe abdominal
  pain
  A specimen bottle would be given to you for collection of tissue mass passed
  vaginally. Please send it to our general gynaecology ward for pathological
  examination, if any, at your earliest convenience.
  Ultrasound assessment one week later to ascertain whether miscarriage is
  complete

Remarks
The information contained is very general, the list of complications is not exhaustive
and other unforeseen complications may occasionally occur. In special patient groups,
the actual risk may be different. For further information please contact your doctor.

				
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