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. 2003 Sep;53(494):704–708.

The natural course of spontaneous miscarriage: analysis of signs and symptoms in 188 expectantly managed women.

Margreet Wieringa-de Waard 1, Willem M Ankum 1, Gouke J Bonsel 1, Jeroen Vos 1, Petra Biewenga 1, Patrick J Bindels 1
PMCID: PMC1314693  PMID: 15103878

Abstract

BACKGROUND: Expectant management is an alternative for curettage in women with a miscarriage. AIM: 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. DESIGN OF STUDY: Part of a study comparing expectant management with surgical evacuation. SETTING: Two hospitals in Amsterdam. METHOD: 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.

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Selected References

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Associated Data

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Supplementary Materials

Supplementary table 1. Characteristics of expectantly managed women with and without bleeding at inclusion according to completed miscarriage, curettage on request or curettage as emergency procedure.
2003_002-s1.pdf (14.3KB, pdf)

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