title: The natural course of spontaneous miscarriage: analysis of signs and symptoms in 188 expectantly managed women.
abstract: BACKGROUND
  Expectant management is an alternative for curettage in women with a miscarriage.
  
  
  OBJECTIVE
  To assess the pattern of vaginal bleeding and pain in expectantly managed women with a miscarriage, and to analyse the factors predictive of a relatively quick spontaneous loss of pregnancy.
  
  
  METHODS
  Part of a study comparing expectant management with surgical evacuation.
  
  
  METHODS
  Two hospitals in Amsterdam.
  
  
  METHODS
  In expectantly managed women with a miscarriage, the pattern of vaginal bleeding and pain and the probability of a spontaneous loss of pregnancy was analysed.
  
  
  RESULTS
  Of the 188 expectantly managed women 95 (51%) experienced a spontaneous loss of their pregnancy. In women with bleeding at inclusion, 52% had a completed miscarriage loss, while of the women without bleeding but with a coincidentally diagnosed non-viable pregnancy during routine ultrasonographic examination, 46% had a completed miscarriage. In the multivariate analysis an increasing bleeding pattern at inclusion was predictive of a relatively quick spontaneous loss of pregnancy. The median daily levels of bleeding and pain were the most prominent during the first 8 days after the start of the bleeding and decreased thereafter.
  
  
  CONCLUSIONS
  Expectant management is effective in 51% of unselected women with a miscarriage. An increasing bleeding pattern is predictive of a relatively quick spontaneous loss of pregnancy in first-trimester miscarriages. The graphical representation of our findings can be used to inform women about the natural course of miscarriages and a well-informed treatment choice.
authors.affiliation: Department of General Practice/Family Medicine, Academic Medical Center-University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands. m.wieringa@amc.uva.nl
authors.forename: Margreet
authors.initials: M
authors.lastname: Wieringa-de Waard
authors.forename: Willem M
authors.initials: WM
authors.lastname: Ankum
authors.forename: Gouke J
authors.initials: GJ
authors.lastname: Bonsel
authors.forename: Jeroen
authors.initials: J
authors.lastname: Vos
authors.forename: Petra
authors.initials: P
authors.lastname: Biewenga
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bindels
mesh_terms: D000027:Abortion, Incomplete / Q000601:surgery / Q000628:therapy*; D000328:Adult; D002755:Choice Behavior; D003475:Curettage / Q000379:methods; D005260:Female; D006801:Humans; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011295:Prenatal Care / Q000379:methods*