Introduction: First trimester miscarriages complicating 15 to 20% of pregnancies, are the leading cause of gynecology emergencies.
Objectives and methods: This review exhaustively summarized the French and English reports found on Medline data base about the management of first trimester miscarriage.
Results: The treatment of reference remains surgical evacuation. It is generally used to avoid haemorrhage and intrauterine infection but is also required for women who wish an immediate termination of pregnancy. Recently, alternatives have been proposed, such as expectant management or medical treatment by misoprostol, to improve patient satisfaction and to reduce complications and costs generated by surgery. Expectant management allows to avoid curettage in most of incomplete miscarriages without any increase of the rate of complications or bleeding duration. Vaginal misoprostol allows complete expulsion in 70 to 90% of missed pregnancies without any increase of the rate of complications.
Conclusion: Today, we can propose to motivated and informed patients an alternative to surgical treatment but large randomized studies still are needed to assess benefits and risks for each method.