Management of incomplete miscarriage in the 1st trimester, at primary health care level

O02.1

Both Manual Vacuum Aspiration (MVA) and medical evacuation are equally effective for miscarriage.

GENERAL MEASURES

  • Counselling.
  • Evacuation of the uterus.

MEDICINE TREATMENT

Medical evacuation: O04.9

  • Misoprostol, PV, 800mcg every 3 hours for 2 doses.
    • Repeat after 24 hours if necessary.

OR

  • Misoprostol, SL, 600 mcg every 3 hours for 2 doses
    • Repeat after 24 hours if necessary.

LoE:III[2]

Manual vacuum aspiration:

Routine analgesia for vacuum aspiration:

  • Morphine, IM, 0.1 mg/kg 30 minutes before aspiration procedure, to a maximum of 10 mg (Doctor prescribed).

LoEIII[3]

Alternatively, consider paracervical block if trained in technique.

Oral analgesia as required for 48 hours:

  • Paracetamol, oral, 1 g 4–6 hourly when required
    • Maximum dose: 15 mg/kg/dose.
    • Maximum dose: 4 g in 24 hours.

LoEIII[4]

AND

  • Ibuprofen, oral, 400 mg 8 hourly with or after a meal.

LoEIII[5]

Follow up after one week to ensure that bleeding has stopped.

REFERRAL

  • Unsafe miscarriage.
  • Miscarriage ≥ 13 'weeks' gestation.
  • Anaemia.
  • Haemodynamic instability.
  • Failed medical evacuation.