Revisión sistemática de método expectante, quirúrgico y médico en el manejo de la finalización espontanea del embarazo en el primer trimestre

Abstract

Introduction: Spontaneous abortion during the first trimester of pregnancy is a common event that affects approximately 25% of women at some point in their lives. There are three main approaches to its management: expectant management, surgical interventions, and pharmacological methods. The management method of this phenomenon is a topic of debate in the field of obstetrics and gynecology; therefore, it is crucial to determine the most effective and safe approach for its management.

Overall Objective: This systematic review aims to analyse and compare the relative efficacy and safety of surgical and pharmacological methods for managing spontaneous abortion during the first trimester of pregnancy.

Methodology: A comprehensive literature search was conducted in relevant medical databases, including PubMed, Redalyc, Scielo, and Proquest, for relevant studies published from September 2018 to September 2023, following the PRISMA methodology. Randomized studies comparing expectant, medical, and surgical management in any combination for early spontaneous abortion management will be included. The primary outcome was the complete evacuation of products of conception, and the secondary outcome was a set of resultant complications.

Results: Fifteen randomized trial studies were analysed, with a total of 3,311 participating women. In the treatment of spontaneous abortion during the first trimester, the expectant approach proves to be less effective in achieving complete evacuation of products of conception compared to other therapeutic options. In contrast, surgical treatments demonstrate higher efficiency compared to expectant and medical management. Although safety profiles are similar between medical, expectant, and surgical aspiration techniques (manual or electric), curettage stands out as less safe than any of the other alternatives.