I am having a miscarriage. How should this be treated?

Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial).Trinder J,Brocklehurst P, Porter R,Read M,Vyas S,Smith L.

Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB. jo. Trinder@bristol. Ac.uk

Objectives:

To ascertain whether a clinically important difference exists in the incidence of gynaecological infection between surgical management and expectant or medical management of miscarriage.

Design:

Randomised controlled trial comparing medical and expectant management with surgical management of first trimester miscarriage.

Setting:

Early pregnancy assessment units of seven hospitals in the United Kingdom.

Participants:

Women of less than 13 weeks' gestation, with a diagnosis of early fetal demise or incomplete miscarriage.

Interventions:

Expectant management (no specific intervention); medical management (vaginal dose of misoprostol preceded, for women with early fetal demise, by oral mifepristone 24-48 hours earlier); surgical management (surgical evacuation).

Settings, Design and Main Outcome Measures:

Confirmed gynaecological infection at 14 days and eight weeks; need for unplanned admission or surgical intervention.

Results:

1200 women were recruited: 399 to expectant management, 398 to medical management, and 403 to surgical management. No differences were found in the incidence of confirmed infection within 14 days between the expectant group (3%) and the surgical group (3%) (risk difference 0.2%, 95% confidence interval - 2.2% to 2.7%) or between the medical group (2%) and the surgical group (0.7%, - 1.6% to 3.1%). Compared with the surgical group, the number of unplanned hospital admissions was significantly higher in both the expectant group (risk difference - 41%, - 47% to - 36%) and the medical group (- 10%, - 15% to - 6%). Similarly, when compared with the surgical group, the number of women who had an unplanned surgical curettage was significantly higher in the expectant group (risk difference - 39%, - 44% to - 34%) and the medical group (- 30%, - 35% to - 25%).

Conclusions:

The incidence of gynaecological infection after surgical, expectant, and medical management of first trimester miscarriage is low (2-3%), and no evidence exists of a difference by the method of management. However, significantly more unplanned admissions and unplanned surgical curettage occurred after expectant management and medical management than after surgical management.

Please click on the required question.

• 1  What is a miscarriage?
• 2  What are the different types of miscarriage?
• 3  How accurate are pregnancy tests?
• 4 What is a blighted ovum?
• 5 I have had a hydatidiform mole. What is this?
• 6 Why did I have a spontaneous miscarriage?
• 7 How frequently do miscarriages occur?
• 8 I am miscarrying. How should this be treated?
• 8a Can miscarriage result in anxiety and depression?
•  9 What is meant by recurrent miscarriage?
• 10 I have a problem with recurrent miscarriage. What is the chance of my next pregnancy being successful?
• Q 12.11 Recurrent Miscarriage I have miscarried again. Why does this keep happening?
• 12 What congenital problems might be associated with recurrent miscarriage and how could they be treated?
• 13 What traumatic conditions can cause recurrent miscarriage and how can they be treated?
• 14 Can infection cause recurrent miscarriage and would treatment help?
• 15 Could a metabolic disorder cause recurrent miscarriage?
• 16 Could a hormonal problem account for recurrent miscarriage and would hormone treatment help me?
• 17 Could an autoimmune problem cause recurrent miscarriage and how could this be treated?
• 18 Could a tumour cause recurrent miscarriage?
• 19 What degenerative processes may be associated with recurrent miscarriage?
• 20 After every miscarriage I become more depressed. Could this account for the problem?
• 21 Is it always possible to explain recurrent miscarriage?
• 22 I have a problem with recurrent miscarriage. What treatment is available to ensure that this does not happen again?
• 23 What is an ectopic pregnancy?
• 24 How frequently do ectopic pregnancies occur?
• 25 Why do ectopic pregnancies occur?
• 26 How can an ectopic pregnancy be diagnosed?
• 27 How can an ectopic pregnancy be treated?
• 28 Where can I obtain more information?
• 29 Support Groups.
  

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.