Title : The effectiveness of surgical management of miscarriage at royal united hospitals, bath an audit
Abstract:
Introduction: Miscarriage is the spontaneous loss of pregnancy up until 24 gestation weeks. Surgical Management Of Miscarriage (SMOM) includes Manual Vacuum Aspiration (MVA) and Evacuation of Retained Products (ERPC). Although largely successful, complications like infection, bleeding, Retained Products Of Conception (RPOC) and Intrauterine Adhesions (IUA) may occur. Additional surgery, generally hysteroscopic resection or ERPC, can treat RPOC.
Aims: To investigate SMOM success rates at Royal United Hospitals, Bath against national standards.
Methods: Retrospective audit using electronic patient notes for data collection. 190 patients were initially identified who had undergone SMOM (including Surgical Termination Of Pregnancy (STOP) between July 2024 and December 2024. Upon data exclusion, 165 patient notes were analysed.
Results and Discussion: 87.3% ERPC, 6.1% STOP, 4.8% MVA and 1.8% Hysteroscopy-assisted ERPC (H+ERPC) were delivered. SMOM were delivered as either primary (67.9%), secondary (24.2%) or tertiary (7.9%) miscarriage management attempts. 7.1% of all SMOM (including five unsuccessful SMOM attempts for which further surgery was required) resulted in a complication: RPOC (8/170), IUA (1/170) and intraoperative bleeding (3/170). No SMOM reported infection. However, 4.7% of all SMOM reported RPOC, exceeding the national standard (4%). However, this was not statistically significant (z=0.47, p=0.32) given the small sample size of our study. Nevertheless, 95.3% of all SMOM resulted in complete miscarriage, which is within the expected ranges determined by RCOG and various studies. No significant differences in complication rates amongst surgeon seniority (p=0.11), intraoperative ultrasound use (p=0.6), and maternal BMI >35kg/m2 (p=0.4) were observed.
Conclusion: SMOM-related RPOC rate was higher than expected, although not statistically significant. Clinically, however, SMOM failure impacts on the physical and emotional stability of patients, as well as the additional healthcare costs associated with further management. Transvaginal ultrasound-guided SMOM has shown to reduce RPOC, hence, its use and specific training to surgeons should be incorporated in our practice.
