From the FDA Drug Label
In the first trimester, curettage is generally considered primary therapy. In second trimester abortion, oxytocin infusion will often be successful in emptying the uterus. Other means of therapy, however, may be required in such cases Adjunctive therapy in the management of incomplete or inevitable abortion.
The recommended management for an active miscarriage may include oxytocin infusion as an adjunctive therapy in the management of incomplete or inevitable abortion. The dosage and administration of oxytocin for this indication are described in the drug label 1 and 1.
- Intravenous infusion with physiologic saline solution or 5% dextrose in physiologic saline solution to which 10 units of oxytocin have been added should be infused at a rate of 20 to 40 drops/minute.
- However, curettage is generally considered primary therapy in the first trimester. In the second trimester, oxytocin infusion will often be successful in emptying the uterus, but other means of therapy may be required in such cases.
From the Research
For an active miscarriage, the most effective management approach is medical management with misoprostol, as it is more effective than expectant management for complete evacuation of the uterus, with a success rate of 66% within 10 days, as shown in the study by 2. This approach uses medications to expedite the process, with the most effective regimen being misoprostol 800mcg vaginally or buccally, repeated if needed after 24 hours. The choice between medical, expectant, or surgical management depends on patient preference, gestational age, bleeding severity, infection risk, and medical history. Some key points to consider include:
- Medical management with misoprostol is associated with more pain than expectant management, but it is a safe and effective option, as reported in the study by 2.
- Expectant management involves waiting for the miscarriage to complete naturally without intervention, which may take 2-6 weeks but avoids procedure risks, as discussed in the study by 3.
- Surgical management involves vacuum aspiration or dilation and curettage (D&C), which provides the quickest resolution and tissue confirmation but carries procedural risks, as mentioned in the study by 4. Patients should be monitored for complications including heavy bleeding, signs of infection, or persistent pain, and follow-up should include pregnancy testing 2-4 weeks after treatment to confirm complete expulsion of pregnancy tissue, as recommended in the study by 5. Each approach has similar long-term outcomes regarding future fertility, though surgical management offers the most rapid resolution, as noted in the study by 6. It is essential to provide detailed counseling to empower patients to make educated decisions about their management, considering the type of miscarriage and its influence on the relative success rates of each treatment option, as emphasized in the study by 5.