General Obstetrics and Gynecology
A comparison of the psychologic impact and client satisfaction of surgical treatment with medical treatment of spontaneous abortion: A randomized controlled trial*,**

https://doi.org/10.1067/mob.2001.117661Get rights and content

Abstract

Objective: The purpose of this study was to compare the psychologic impact and client satisfaction of routine surgical evacuation of the uterus with medical evacuation in cases of spontaneous abortion. Study Design: This was a prospective, randomized controlled trial. Two hundred eighteen women who were admitted to a university teaching hospital after spontaneous abortion and who consented to the study were randomized to routine surgical evacuation or medical evacuation of the uterus with the use of misoprostol. General psychologic well-being, level of depression, fatigue symptoms, psychiatric morbidity, social functioning, client satisfaction, and acceptance were measured in the 2 groups. Results: The 2 groups did not differ in any of the measured psychological outcomes. Significantly more participants who experienced successful evacuation of the uterus with the misoprostol protocol would choose the same mode of treatment if they were able to choose again. However, participants for whom the medical treatment failed to evacuate the uterus and subsequent surgical evacuation was required are significantly less satisfied with the treatment. Conclusion: Medical treatment of spontaneous abortion with misoprostol is psychologically safe and more compatible with the ethnomedical beliefs of our Chinese participants. Client satisfaction and acceptance should be taken into consideration in the evaluation of treatment outcomes. (Am J Obstet Gynecol 2001;185: 953-8.)

Section snippets

Material and methods

Two hundred eighteen women who were admitted to the gynecologic unit from October 1995 through June 1996 with a clinical diagnosis of spontaneous abortion, a positive urinary pregnancy test, and transvaginal sonographic evidence of retained products of conception (POCs) were asked to consent for randomization before treatment. Informed consent was obtained according to a research protocol approved by the Clinical Trials Ethics Committee. Participants were excluded from randomization if they had

Participants

During the study period, 784 patients were admitted for spontaneous abortions to the unit and were therefore potentially eligible for recruitment. However, recruitment for the study occurred only during week days when 570 patients were admitted. Of these, 48 women were not considered because, in the opinion of the attending doctor, there were medical reasons that they should not be randomized. Two hundred sixty-seven women declined participation, and a further 37 women were not approached by

Comments

The results of this study show that a more conservative approach to the treatment of spontaneous abortion, as detailed in the misoprostol protocol, is psychologically safe and generally acceptable to the participants. Women who were treated with the misoprostol protocol were similar to women who were treated with a conventional surgical approach (in terms of short- and medium-term psychologic well-being and depression), as reflected by the 6-week and 6-month GHQ and BDI scores. The SCID

Acknowledgements

We thank M. O'Hara for his comments and suggestions.

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    *

    Supported by the Health Services Research Fund of Hong Kong Hospital Authority, Hong Kong (grant number 511007).

    **

    Reprint requests: Dominic T. S. Lee, MD, Department of Psychiatry, The Chinese University of Hong Kong, Sha Tin, NT, Hong Kong, China. E-mail: [email protected].

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