The terminology of pathological intrauterine pregnancies has been reviewed in the recommendations of a study group of the RCOG in 19971. The terminology used in our paper follows these recommendations.
In our opinion patients who present with symptoms of an ongoing miscarriage with an open cervix, i.e. products of conception in the cervical os, will not need any treatment at all, unless clinical symptoms such as heavy bleeding or pain occur. In uncomplicated cases with an open cervix the miscarriage will resolve spontaneously within a short period of time or following the removal of the products of the conception from the cervix with forceps. In our opinion the category of patients who Ahmed et al. refer as inevitable abortion, with an open cervix, should not be included in trials assessing different treatments for miscarriage. In our department about 1/3 of patients with miscarriages will present with a complete miscarriage, or nearly complete (“pregnancy products in the cervix” or retained products of conception < 15mm in the antero-posterior diameter of the uterine cavity). This patient category will not be considered for active treatment in our department.
We included in our study only patients with symptoms (bleeding) and intrauterine non-viable products of conception > 15 mm in the antero-posterior diameter of the uterine cavity. This category of patients should, in our opinion, be differentiated from patients without symptoms, i.e. intrauterine anembryonic pregnancy or fetal demise (“missed abortion” and “blighted ovum”), where both conservative and pharmacological management has been tried with varying results2–5.