Clinical Audit of Management of First Trimester Missed Miscarriage at Central Aga Hospital

Early missed miscarriage represents 10% of all clinically recognized pregnancies. Introducing the best effective management for such cases is highly important for both patients and healthcare providers. To assess the management of the first trimester missed miscarriage at Central Aga Hospital and put a plan of quality improvement of this healthcare provision aiming to close the gap between the current practice and the best standards. A Criterion based clinical audit was conducted at Central Aga hospital, for one year from August 1st, 2018, to July 30th, 2019. Seventy-three cases of the first trimester missed miscarriage were studied. All the collected data were compared to ACOG (2015) and FIGO (2017) Standards. Twenty cases were managed expectantly with a 15% success rate. Sixty-three cases were managed medically by misoprostol (49 cases from the start and 14cases after failed expectant management), with a 47.6% success rate. The duration of misoprostol treatment was lower in the successful group than the failed one with a highly statistically significant difference (1.3±1.21vs 3.2±2.2 days at P=0.001 respectively). The vaginal or sublingual routes of misoprostol administration showed the highest rate of effectiveness (33.3% and 33.3% respectively). Thirty-three cases were managed surgically (4 cases from the start, 3 cases after failed expectant and 26 cases after failed medical) with complete evacuation. There was a gap between early missed miscarriage management at Central Aga hospital and that of the comparable standards. A needed plan of improvement was put, and re-auditing is required.