Abstract

Outpatient Management of Incomplete Miscarriages: An Initiative for Quality Improvement

Abdulhamid Azhaghdani, Sufia Athar, Hanen Mrabet, Batoul Ibrahim, Huda Yousha, Huda belhaj, Mohammed Gaber, Lolwa Alansari

 

Objective

Outpatient medical management of incomplete miscarriage using Misoprostol is one of the options of management of miscarriage. This method not only reduces the need for hospitalization and minimizes the economic burden but offers higher patients’ satisfaction and improved compliance. In our hospital, patients were usually offered the medical management as an inpatient option. To minimize the admissions and improve patient satisfaction, we initiated the medical management as an outpatient means for quality improvement.

Objective: The QIP aimed at improving the quality service by

-Reduced admission rates

-Effectively treat post miscarriage complications.

-Reduction in patient's waiting time.

-Reduced rate of surgical evacuation of incomplete miscarriage cases.

-Improve patients’ satisfaction.

 

Type: Quality Improvement Project (QIP)

Methods:

In women with ultrasound findings of products of conception less than 20 mm, intervention was applicable. Risk assessment of patients with incomplete miscarriage was done in ED. After the basic laboratory investigations, patients were offered 600 micrograms of misoprostol on Day 1 and observed in ED for 4 hours. If no active bleeding was observed, out-patient follow-up, clinical and ultrasound reassessment on Day 7 was advised. The efficacy and the safety of Misoprostol and reductions in admissions was assessed.

 

Results:

Rate of hospital admissions for incomplete miscarriage cases reduced by 70% in 2022.

Due to this significant reduction in in-patient admissions, patient’s waiting time and length of stay reduced significantly. None of them required surgical management. There were no complications in the last 18 months.  Patient satisfaction from medical management increased to 98% by December 2022. The results were statistically significant (p<0.05).

 

Conclusion

Use of misoprostol as a single dose as out-patient treatment proved to be more effective than inpatient management with significantly reduced admission rates, complications and need for surgical evacuation. It also enhanced the patients’ satisfaction. Patient selection is the key to the successful outcome.