Treatment of miscarriage: current practice and rationale.

OBJECTIVE: To describe health service use during miscarriage and medical treatment of miscarriage in Finland and the rationales behind them.
METHODS: Description of the treatment practices was based on a survey sent to a nationally representative sample of 3000 Finnish women age 18-44 years in 1994, on national hospital care register data from 1988 and 1995, and on treatment recommendations in textbooks (from 1950-1994) for physicians, nurses, and midwives. Published, controlled studies that were identified through various systematic searches were reviewed for scientific evidence justifying the identified practices.
RESULTS: According to the survey, 97% of the 326 women who had a miscarriage had visited a physician, and 74% were treated as inpatients. The hospital registers indicated that most (at least 84% in 1988, and 88% in 1995) women who had a miscarriage had their uteri evacuated operatively. According to the textbook recommendation, care by a physician, inpatient care, and routine uterine evacuations were seen as norms. No controlled studies providing empirical support for these practices were found. In general, studies were few and recent, and they placed emphasis on different evacuation methods.
CONCLUSION: Current treatment of miscarriage is not based on controlled studies. All aspects of care, from best care provider to various interventions, urgently need further evaluation by trials.