The management of miscarriage

Women diagnosed with incomplete and delayed miscarriage are faced with three options for their subsequent management: expectant, medical or surgical. Health-care practitioners must empower patients to make educated decisions about their own management by providing them with sufficient information in a readily understandable format. This can be difficult both for the patient and the staff in what is often an understandably, highly emotional situation. Detailed counselling is an essential part of the process as psychological outcomes have been shown to be improved when women feel in control of the decision-making process. In this article, we discuss each of the treatment options in detail, and explore how the type of miscarriage influences their relative success rates. We also consider the comparative risks of bleeding, infection, side effects of drugs, pain scores and quality-of-life scores associated with each method through evidence derived from systematic reviews, meta-analyses and randomised controlled trials.