Outcomes of medical management of miscarriage in an early pregnancy setting

Miscarriage is the most common complication of pregnancy. Medical management with misoprostol offers an alternative to surgical intervention. The aim of this study was to evaluate the outcomes of medical management of first-trimester miscarriage in the setting of an early pregnancy unit at a tertiary maternity hospital.

This observational cohort study prospectively investigated the outcomes of medical management for first-trimester miscarriage in 186 women recruited over 18 months. The treatment protocol consisted of two doses of 600 mcg of oral misoprostol, with follow-up ultrasound 10-14 days later.

An overall efficacy rate of 68.8% (128/186), with a complete miscarriage rate of 47.5% (87/193) at the first follow-up scan (10-14 days) was achieved. Incomplete miscarriages and missed miscarriages had similar outcomes: 47.1% (8/17) and 46.7% (79/169) respectively. Expectant management following failed medical management showed higher complete miscarriage rate (81.5%, 22/27) in comparison with repeat medical management (47.6%, 20/42) (P = 0.005). The complication rate was low, with 4.8% (9/186) requiring unplanned surgical intervention.

We report a low complication rate following medical management of first trimester miscarriage in a study where care is led by patient choice. This study highlights the need for standardized criteria for diagnosing complete miscarriage and the potential benefits of expectant management following failed medical treatment. Future studies with standardized definitions and core outcome sets would facilitate better comparison across trials and inform clinical practice.