The medical management of missed miscarriage: outcomes from a prospective, single-centre, Australian cohort

Objective: To report the prospective outcomes of medical management of missed miscarriage before 13 weeks' gestation from an Australian cohort. Design: Descriptive study of a cohort selected out of a randomised controlled trial. Setting: Outpatient management at a maternity hospital between 1 May 2007 and 28 July 2010. Participants: 264 women requesting medical management of missed miscarriage. Main outcome measures: 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% of 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. Conclusion: The medical management of missed miscarriage on an outpatient basis is safe and effective