Expectant management versus surgical evacuation in first trimester miscarriage: health-related quality of life in randomized and non-randomized patients.
BACKGROUND
Expectant management, although less effective, is an alternative treatment option for surgical evacuation in women with a miscarriage. We assessed health-related quality of life (HRQL) differences over time between expectant and surgical management in women with a miscarriage.


METHODS
Women with a miscarriage were randomized to either expectant (n = 64) or surgical (n = 58) management, and 305 eligible women who refused randomization because of a preference for either treatment option were managed according to their choice following the same clinical protocol (126 expectant, 179 surgical). The main outcome measures were score differences of HRQL during 12 weeks. Repeated measures analysis was applied.


RESULTS
Out of a total of 427 women, 198 were excluded in the questionnaire follow-up, leaving 229 women who participated. Mental health of women allocated to expectant management improved more and earlier (treatment effect) than of women allocated to surgical evacuation. Mental health scores were significantly better in women who chose, rather than women who were randomized, to curettage. The groups managed according to their own preference showed no differences in mental health scores.


CONCLUSIONS
Women with a miscarriage who chose their own treatment had the best HRQL over time, supporting the role of free choice from a clinical point of view. Women without a treatment preference should be encouraged to start with expectant management for psychological reasons.
Wieringa-De Waard
Margreet
M
Academic Medical Center-University of Amsterdam, Department of General Practice/Family Medicine, Amsterdam, The Netherlands. m.wieringa@amc.uva.nl
Hartman
Esther E
EE
Ankum
Willem M
WM
Reitsma
Johannes B
JB
Bindels
Patrick J E
PJ
Bonsel
Gouke J
GJ
D000027:Abortion, Incomplete / Q000523:psychology / Q000601:surgery / Q000628:therapy; D000022:Abortion, Spontaneous / Q000523:psychology / Q000601:surgery* / Q000628:therapy*; D004107:Dilatation and Curettage; D005260:Female; D005313:Fetal Death / Q000601:surgery / Q000628:therapy; D006801:Humans; D008603:Mental Health; D008609:Mental Status Schedule; D017060:Patient Satisfaction; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011788:Quality of Life; D011795:Surveys and Questionnaires