A randomised trial of surgical, medical and expectant management of first trimester spontaneous miscarriage

Background: Medical management and expectant care have been considered possible alternatives to surgical evacuation of the uterus for first trimester spontaneous miscarriage in recent years.Aim: To compare the effectiveness and safety of medical and expectant management with surgical management for first trimester incomplete or inevitable miscarriage.Methods: Forty women were recruited following diagnosis of incomplete or inevitable miscarriage, and randomised to surgical, medical or expectant care via an off-site, computerised enrolment system. The primary outcome was the effectiveness of medical (vaginal misoprostol) and expectant management relative to surgical evacuation, assessed at 10&ndash;14 days and 8 weeks post-recruitment. Infection, pain, bleeding, anxiety, depression, physical and emotional recovery were assessed also. Analysis was by intention-to-treat.Results: Effectiveness at 8 weeks was lower for medical (80.0%) and expectant (78.6%) than for surgical management (100.0%). Two women in the medical group had confirmed infections. Bleeding lasted longer in the expectant group than in the surgical group. There were no significant differences in pain, physical recovery, anxiety or depression between the groups. 54.6%, 42.9% and 57.1% of the surgical, medical and expectant groups respectively would opt for the same treatment again.Conclusion: Expectant care appears to be sufficiently safe and effective to be offered as an option for women. Medical management might carry a higher risk of infection than surgical or expectant care.<br /

Decline of the World’s Saline Lakes

Many of the world\u27s saline lakes are shrinking at alarming rates, reducing waterbird habitat and economic benefits while threatening human health. Saline lakes are long-term basin-wide integrators of climatic conditions that shrink and grow with natural climatic variation. In contrast, water withdrawals for human use exert a sustained reduction in lake inflows and levels. Quantifying the relative contributions of natural variability and human impacts to lake inflows is needed to preserve these lakes. With a credible water balance, causes of lake decline from water diversions or climate variability can be identified and the inflow needed to maintain lake health can be defined. Without a water balance, natural variability can be an excuse for inaction. Here we describe the decline of several of the world\u27s large saline lakes and use a water balance for Great Salt Lake (USA) to demonstrate that consumptive water use rather than long-term climate change has greatly reduced its size. The inflow needed to maintain bird habitat, support lake-related industries and prevent dust storms that threaten human health and agriculture can be identified and provides the information to evaluate the difficult tradeoffs between direct benefits of consumptive water use and ecosystem services provided by saline lakes