Management of miscarriage: a randomized controlled trial of expectant management versus surgical evacuation
Open accessAbstract
BACKGROUND: In many countries, surgical uterine evacuation is the standard treatment for women with a miscarriage, but expectant management has been advocated as an alternative. The choice between the two options cannot be based on published evidence alone, because randomized clinical trials are scarce while generalizability of findings to patients with a strong preference for either management options is unclear. METHODS: In a randomized controlled trial, the complications and efficacy of either expectant or surgical management for miscarriages were compared, and the results in patients who refused randomization and were managed according to their own preference were studied. In total, 122 patients were randomized and 305 were managed according to their choice. RESULTS: No differences were found in the number of emergency curettages and complications between expectant and surgical management. Efficacy at 6 weeks was 30/64 (47%) in women allocated to expectant management, and 55/58 (95%) in women allocated to surgical evacuation. After 7 days, 37% of expectantly managed women had a spontaneous complete miscarriage. After 6 weeks, intention-to-treat analysis including cross-overs showed similar effectiveness (92% versus 100%). Results in the preference groups were comparable with those in the randomized groups. CONCLUSION: In our experience a waiting period of 7 days after diagnosis may prevent 37% of surgical procedures.
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Three small randomised controlled trials have compared expectant management and surgical management of miscarriage.
“Three small randomised controlled trials have compared expectant management and surgical management of miscarriage.5-7”
From Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial) (2006) · cites this paper as [7]
The success rates in this trial were comparable to those in other trials of expectant management of incomplete miscarriage and early fetal demise.
“The success rates in this trial were comparable to those in other trials of expectant management of incomplete miscarriage and early fetal demise.6,7”
From Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial) (2006) · cites this paper as [7]
The available passages contain the paper’s title and bibliographic information, but no results or comparison with other trials. Searches for success rates in expectant management of incomplete miscarriage and early fetal demise returned no passage addressing whether the rates were comparable. (LLM, conf=0.72)
Experimental — accuracy not yet measuredExpectant management efficacy was reduced to 37% after seven days when used to treat women with miscarriage mostly diagnosed as early fetal demise.
“However, efficacy was reduced to 37% after seven days when expectant management was used to treat women with miscarriage mostly diagnosed as early fetal demise.7”
From Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial) (2006) · cites this paper as [7]
The available passages contain the title and bibliographic metadata, but no study results. Searches for the seven-day 37% efficacy figure and early fetal demise found no passage that verifies those details. (LLM, conf=0.73)
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Hooker, A. B., Lemmers, M., Thurkow, A. L., Heymans, M. W., Opmeer, B. C., Brolmann, H. A. M., Mol, B. W., & Huirne, J. A. F. (2014) · Human Reproduction Update · doi:10.1093/humupd/dmt045 · Cited by 478 · see citing works
Trinder, J., Brocklehurst, P., Porter, R., Read, M., Vyas, S., & Smith, L. (2006) · BMJ · doi:10.1136/bmj.38828.593125.55 · Cited by 299 · see citing works
Petrou, S., Trinder, J., Brocklehurst, P., & Smith, L. (2006) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2006.00998.x · Cited by 87 · see citing works
You, J. H. S., & Chung, T. K. H. (2005) · Human Reproduction · doi:10.1093/humrep/dei163 · Cited by 80 · see citing works
Petrou, S., & McIntosh, E. (2009) · Value in Health · doi:10.1111/j.1524-4733.2008.00459.x · Cited by 58 · see citing works
Early pregnancy care over time: should we promote an early pregnancy assessment unit?
van den Berg, M. M. J., Goddijn, M., Ankum, W. M., van Woerden, E. E., van der Veen, F., van Wely, M., & Hajenius, P. J. (2015) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2015.04.008 · Cited by 32 · see citing works
- Authors
- Wieringa-de Waard, M.
- Venue
- Human Reproduction
- Publisher
- Oxford University Press (OUP)
- Published
- 2002-09-01
- Volume
- 17
- Issue
- 9
- Pages
- 2445-2450
- ISSN
- 0268-1161 (ISSN-L)
- 1460-2350
- OpenAlex
- W2099648789
- Cited by
- 81
- References
- 0
- Citations by year
- 2024: 1 · 2023: 5 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 3 · 2017: 6 · 2016: 3 · 2015: 3 · 2014: 3 · 2013: 6 · 2012: 1
- FWCI
- 4.93
- Type
- journal article
- Language
- en
- Open access
- green
- pure.eur.nl
- Licence
- other-oa
- Locations
- Human Reproduction (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Keywords
- miscarriage, expectant management, surgical evacuation, uterine curettage, patient preferences, treatment efficacy, postpartum complications, waiting period
- MeSH terms
- Abortion, Spontaneous, Adult, Choice Behavior, Curettage, Female, Follow-Up Studies, Humans, Time Factors
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