Many women are undergoing unnecessary surgery after miscarriage, according to a report (GP, 6 August 1993).
Most women in the UK who have lost a baby have a D and C-dilation and curettage where the uterus is dilated and its lining scraped to remove any remnants of the fetus. However, Dr Richard Henshaw, researcher and senior lecturer in obstetrics and gynaecology at Aberdeen maternity hospital, predicts that the UK may soon follow the US in waiting for the uterus to empty itself naturally.
He told GP: “We are overtreating the vast majority of women.” The practice of using D and C dates back to the 1930s when it was standard practice following back street abortions. “To remove infected products with curettage was very sensible,” he says. But with medical advances and the advent of legal abortion such drastic treatment is no longer necessary.
A shift in procedure could mean GPs having more of a role in treating women after miscarriage. Richard Beard, Professor of obstetrics and gynaecology at St Mary’s Hospital in London, says: “I would encourage GPs to manage miscarriage initially themselves, provided the woman is within reasonable distance of a hospital and she is adequately supervised.”
Women should be able to choose their treatment. For some of them, “surgical evacuation of the uterus is simple, effective and less traumatic than waiting. But others say surgery denies them the opportunity to grieve, and prefer to wait,” says GP.