Tuesday, February 9, 2010

Medical management of miscarriage snubbed by doctors

The following are examples of the medical community's exclusion of medical management as a choice to women who have miscarried. Some countries including Australia and the UK seem to be in the dark ages when it comes to offering misoprostol and/or mifepristone.

The first example is the Royal Women's Hospital in Victoria (Australia). Their website boasts:

"We are also a major teaching hospital and a medical research leader of world renown...We are an advocate for improvements in women’s health and well-being."

Yet, when you look up
miscarriage management there is a detailed table comparing expectant management (natural expulsion aka waiting to miscarry) to surgical management (ie. D&C). There is simply no mention of medical management (eg. misoprostol), as if it did not exist.

Sydney IVF is, according to its website, 'Australia's leading centre for infertility and IVF treatment.' It even has a Miscarriage Management Program which promises close monitoring for women with recurrent miscarriage. One could be mistaken for thinking that a center specializing in miscarriage management for recurrent miscarriages would offer medical management as the risk of Asherman's syndrome increases with each D&C. However, it's protocol for managing miscarriages is limited to D&C or natural expulsion:

"It is important to be certain all the tissue relating to the pregnancy is removed, either naturally, or with a D&C (a "curette")."

The website has an extensive glossary of medical terms. Misoprostol is not included.

The third offender is the
Women's Health website (UK) which describes only two choices for miscarriage, D&C or natural expulsion. Unfortunately it also fails to mention Asherman's syndrome as a possible complication.

And these are just drops in the ocean.

Meanwhile, abortion clinics in Australia are quick to advertize that they offer the 'abortion pill' . They are referring to misoprostol and mifepristone. It's unfortunate that these drugs have become synonymous with abortions when they can also be used effectively for treatment of miscarriage. These drugs should be made available to ALL women, not just those wanting to terminate a pregnancy. As a society, we must ask why women with an undesired normal pregnancy can receive a treatment regimen that is safer (ie. drugs such as misoprostol) than that standardly used for women with a desired abnormal pregnancy.

As for surgical termination, the website claims that : "In expert hands, termination of pregnancy is the safest procedure in gynaecology." This is absolutely false. Not only because I can think of several other gynecological procedures which are much safer such as hysteroscopy when performed by experts, ultrasound, HSG, SHG, and pap smears. Just as D&C can cause Asherman's syndrome following miscarriage, it can do so when performed for termination, REGARDLESS of whether you have 'infections or endometriosis' as mentioned on the website. Most studies on Asherman's syndrome include women who acquired the condition from surgical termination (as well as other D&Cs and uterine surgery). Therefore medical abortion can also prevent Asherman's syndrome. I believe that if the trend for medical abortion continues, there will be very few cases of AS in this population of women.

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