Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2006 May 27;332(7552):1235-40.
doi: 10.1136/bmj.38828.593125.55. Epub 2006 May 17.

Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial)

J Trinder  1 , P Brocklehurst, R Porter, M Read, S Vyas, L Smith
Affiliations
Randomized Controlled Trial

Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial)

J Trinder et al. BMJ. .

Abstract

Objective: To ascertain whether a clinically important difference exists in the incidence of gynaecological infection between surgical management and expectant or medical management of miscarriage.

Design: Randomised controlled trial comparing medical and expectant management with surgical management of first trimester miscarriage.

Setting: Early pregnancy assessment units of seven hospitals in the United Kingdom.

Participants: Women of less than 13 weeks' gestation, with a diagnosis of early fetal demise or incomplete miscarriage.

Interventions: Expectant management (no specific intervention); medical management (vaginal dose of misoprostol preceded, for women with early fetal demise, by oral mifepristone 24-48 hours earlier); surgical management (surgical evacuation).

Main outcome measures: Confirmed gynaecological infection at 14 days and eight weeks; need for unplanned admission or surgical intervention.

Results: 1200 women were recruited: 399 to expectant management, 398 to medical management, and 403 to surgical management. No differences were found in the incidence of confirmed infection within 14 days between the expectant group (3%) and the surgical group (3%) (risk difference 0.2%, 95% confidence interval - 2.2% to 2.7%) or between the medical group (2%) and the surgical group (0.7%, - 1.6% to 3.1%). Compared with the surgical group, the number of unplanned hospital admissions was significantly higher in both the expectant group (risk difference - 41%, - 47% to - 36%) and the medical group (- 10%, - 15% to - 6%). Similarly, when compared with the surgical group, the number of women who had an unplanned surgical curettage was significantly higher in the expectant group (risk difference - 39%, - 44% to - 34%) and the medical group (- 30%, - 35% to - 25%).

Conclusions: The incidence of gynaecological infection after surgical, expectant, and medical management of first trimester miscarriage is low (2-3%), and no evidence exists of a difference by the method of management. However, significantly more unplanned admissions and unplanned surgical curettage occurred after expectant management and medical management than after surgical management. TRIAL REGISTRATION NATIONAL RESEARCH REGISTER: N0467011677/N0467073587.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow of patients through MIST trial
See this image and copyright information in PMC

Comment in

References

    1. Nybo Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M. Maternal age and fetal loss: population based register linkage study. BMJ 2000;320: 1708-12. - PMC - PubMed
    1. Chung TK, Lee DT, Cheung LP, Haines CJ, Chang AM. Spontaneous abortion: a randomized, controlled trial comparing surgical evacuation with conservative management using misoprostol. Fertil Steril 1999;71: 1054-9. - PubMed
    1. Jurkovic D. Modern management of miscarriage: is there a place for non-surgical treatment? Ultrasound Obstet Gynecol 1998;11: 161-3. - PubMed
    1. Cahill DJ. Managing spontaneous first trimester miscarriage. BMJ 2001;322: 1315-6. - PMC - PubMed
    1. Chipchase J, James D. Randomised trial of expectant versus surgical management of spontaneous miscarriage. Br J Obstet Gynaecol 1997;104: 840-1. - PubMed

Publication types