Management of miscarriage: a randomized controlled trial of expectant management versus surgical evacuation.
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.


CONCLUSIONS
In our experience a waiting period of 7 days after diagnosis may prevent 37% of surgical procedures.
Department of General Practice/Family Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands. m.wieringa@amc.uva.nl
Margreet
M
Wieringa-de Waard
Jeroen
J
Vos
Gouke J
GJ
Bonsel
Patrick J E
PJ
Bindels
Willem M
WM
Ankum
D000022:Abortion, Spontaneous / Q000601:surgery / Q000628:therapy*; D000328:Adult; D002755:Choice Behavior; D003475:Curettage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D013997:Time Factors