Ist eine Curettage nach Abortus completus noch zeitgemäß

Purpose: To determine whether sonographically complete first trimester spontaneous abortion can be treated safely without curettage and whether additional hormone treatment is of benefit. Patients und Methods: Patients with complete spontaneous abortion up to 13 weeks' gestation and an endo-metrial width up to 8mm were randomised to one of three groups. Patients in Group A (n = 15) underwent dilatation and curettage, those in Group B (n = 20) observation only, and those in Group C (n = 15) observation with hormone treatment. All patients were followed up until hCG was no longer detectable and until bleeding ceased. Results: There was no difference in hCG clearance time among the three groups (median ± IQR; 18 ± 9,15 ± 6.75, 14 ± 15 days). The duration of bleeding was significantly shorter in group A than in group C (median ± IQR; 1 ± 1 vs. 4 ± 1 days, p = 0.005); group B (2 ± 6 days) did not differ from group A or C. Additional hormone treatment did not provide a benefit. One patient in group C developed a tubal pregnancy; all other patients had an uneventful follow-up and none of the patients in group B or C required subsequent curettage. conclusion: Curettage can be avoided in patients with complete first trimester spontaneous abortion if transvaginal ultrasonography shows an empty uterus. hCG measurements are a useful marker to confirm complete resolution of trophoblast. Additional hormone treatment is not warranted.