Spontaneous Miscarriage Management Experience: A Systematic Review.

BACKGROUND: The estimated frequency of spontaneous miscarriage is about a quarter of all clinically identified pregnancies in the United States. Women typically go to the emergency department (ED) or outpatient clinic when they experience symptoms, including but not limited to vaginal bleeding, abdominal pain, and contractions. The care that is provided varies from place to place. METHODS: Researchers searched articles from 2010 to 2021 for reports mentioning treatment for spontaneous abortion. Search terms included "miscarriage aftercare" and "spontaneous abortion care," seeking articles addressing the psychological effects of miscarriage and reporting patient experiences in different clinical settings. Data were independently reviewed, graded for evidence quality, and assessed for risk bias using the AMSTAR checklist. RESULTS: The search strategy yielded 2,275 articles, six of which met the inclusion criteria. Conservative, medical, and surgical management were provided, with surgical management being more common among women with higher education and socioeconomic status. All qualitative studies reported dissatisfaction with care provided in the emergency department, partially due to a lack of emotional support. Structured bereavement intervention was beneficial for women experiencing early pregnancy loss and led to fewer reports of despair. The quantitative studies referenced interventions that aided patients in coping with pregnancy loss and identified several factors influencing the type of treatment received as well as the patient's ability to cope with feeling depressed following a miscarriage. CONCLUSION: Psychological management is not regularly addressed in the emergency department, and protocols including bereavement education for healthcare providers as well as patient involvement in management would improve the overall patient experience with spontaneous miscarriage care.

Adverse events with universal use of iodixanol for CT: comparison with iohexol.

OBJECTIVE: To evaluate the incidence of adverse events with the universal use of iodixanol for computed tomography (CT) and compare it with periods when iohexol was used exclusively. METHODS: Iodixanol was used for CT in 15,142 consecutive patients and compared with 22,044 patients who received iohexol. RESULTS: Adverse events were observed in 116 patients (0.77%) who received iodixanol and in 54 patients (0.25%) who received iohexol (P < 0.001). Immediate and delayed adverse events were seen in 76 and 40 patients (0.50% and 0.26%, respectively) who received iodixanol and in 52 and 2 patients (0.24% and 0.01%, respectively) who received iohexol, respectively (immediate, P = 0.002; delayed, P < 0.001). Adverse events with iodixanol and iohexol were as follows: mild, 89% and 98%; moderate, 10% and 2%; and severe, 1% and 0%, respectively. CONCLUSIONS: Adverse events occurred in less than 1% of patients receiving either contrast agent. However, the incidence of immediate and delayed adverse events was significantly higher with iodixanol than iohexol.