title: Clinical inquiries. How long is expectant management safe in first-trimester miscarriage?
abstract: More than 80% of women with a first-trimester spontaneous abortion have complete natural passage of tissue within 2 to 6 weeks with no higher complication rate than that from surgical intervention (strength of recommendation [SOR]: A, based on multiple randomized controlled trials [RCTs] and cohort studies). Expectant management is successful within 2 to 6 weeks without increased complications in 80% to 90% of women with first-trimester incomplete spontaneous abortion and 65% to 75% of women with first-trimester missed abortion or anembryonic gestation (presenting with spotting or bleeding and ultrasound evidence of fetal demise) (SOR: B, based on multiple cohort studies). There is no difference in short-term psychological outcomes between expectant and surgical management (SOR: B, based on RCT). Women experiencing spontaneous abortion with unstable vital signs, uncontrolled bleeding, or evidence of infection should be considered for surgical evacuation (SOR: C, expert opinion).
authors.affiliation: Valley Medical Center Family Practice Residency, Renton, WA, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Butler
authors.forename: Gary
authors.initials: G
authors.lastname: Kelsberg
authors.forename: Leilani
authors.initials: L
authors.lastname: St Anna
authors.forename: Paul
authors.initials: P
authors.lastname: Crawford
mesh_terms: D000022:Abortion, Spontaneous / Q000175:diagnosis / Q000628:therapy*; D002986:Clinical Trials as Topic; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First