title: The medical management of missed miscarriage: outcomes from a prospective, single-centre, Australian cohort.
abstract: OBJECTIVE
  To report the prospective outcomes of medical management of missed miscarriage before 13 weeks' gestation from an Australian cohort.
  
  
  METHODS
  Descriptive study of a cohort selected out of a randomised controlled trial.
  
  
  METHODS
  Outpatient management at a maternity hospital between 1 May 2007 and 28 July 2010.
  
  
  METHODS
  264 women requesting medical management of missed miscarriage.
  
  
  METHODS
  Number of doses of misoprostol required, unscheduled visits for care, findings at ultrasound follow-up, requirement for surgical management, number of cases of gestational trophoblastic disease (GTD), and self-reported patient experience.
  
  
  RESULTS
  107 women (40.5%) received a repeat dose of misoprostol, and 79 women (29.9%) made unscheduled visits for care. Among the 241 women with Day 7 ultrasound follow-up, a gestational sac was found in 32 women (13.3%), indicating failure of medical management. Complete miscarriage was induced without the need for surgery in 206 women (78.0%). Surgery was performed as an emergency in 13 women (4.9%). Twelve women (4.5%) had surgery for ongoing bleeding after medical management, and four of these did not have chorionic villi on histopathological examination. Five women (1.9%) had GTD, which was managed incidentally under the protocol. Among those who returned patient questionnaires, 73.0% participants (116/159) indicated that they would recommend medical management of miscarriage to other women, while 18.2% (29/159) indicated that they would undergo surgery next time.
  
  
  CONCLUSIONS
  The medical management of missed miscarriage on an outpatient basis is safe and effective.
  
  
  BACKGROUND
  ACTRN12612000150842.
authors.affiliation: Mater Mothers' Hospital, Brisbane, QLD, Australia. Scott.Petersen@mater.org.au
authors.forename: Scott G
authors.initials: SG
authors.lastname: Petersen
authors.forename: Anneliese R
authors.initials: AR
authors.lastname: Perkins
authors.forename: Kristen S
authors.initials: KS
authors.lastname: Gibbons
authors.forename: Julia I
authors.initials: JI
authors.lastname: Bertolone
authors.forename: Kassam
authors.initials: K
authors.lastname: Mahomed
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000030:Abortion, Missed / Q000188:drug therapy*; D000284:Administration, Oral; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage*; D017060:Patient Satisfaction; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol