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
. 2009 Oct 8:339:b3827.
doi: 10.1136/bmj.b3827.

Incidence of pregnancy after expectant, medical, or surgical management of spontaneous first trimester miscarriage: long term follow-up of miscarriage treatment (MIST) randomised controlled trial

Lindsay F P Smith  1 , Paul D Ewings, Catherine Quinlan
Affiliations
Randomized Controlled Trial

Incidence of pregnancy after expectant, medical, or surgical management of spontaneous first trimester miscarriage: long term follow-up of miscarriage treatment (MIST) randomised controlled trial

Lindsay F P Smith et al. BMJ. .

Abstract

Objectives: To compare fertility rates after the three methods of managing early miscarriage in women recruited to the MIST (miscarriage treatment) randomised controlled trial.

Setting: Early pregnancy clinics of acute hospitals in the south west region of England.

Participants: 1199 women who had had an early miscarriage (<13 weeks) confirmed by scan.

Intervention: Expectant, medical, or surgical management.

Main outcome measures: Self reported pregnancy rates and live birth rates.

Results: Of 1199 women recruited to the trial, 1128 consented to follow-up. Of these, 762 women replied giving pregnancy details (68% response rate). Respondents were representative of the trial participants. The live birth rate five years after the index miscarriage was similar in the three management groups: 177/224 (79%, 95% confidence interval 73% to 84%) in the expectant management group, 181/230 (79%, 73% to 84%) in the medical group, and 192/235 (82%, 76% to 86%) in the surgical group. There was also no significant difference according to previous birth history. Older women and those with previous miscarriages were significantly less likely to subsequently give birth.

Conclusion: Method of miscarriage management does not affect subsequent pregnancy rates with around four in five women giving birth within five years of the index miscarriage. Women can be reassured that long term fertility concerns need not affect their choice of miscarriage management.

Trial registration: National Research Register N0467011677/N0467073587.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

None
Fig 1 Time (years) to live birth after index miscarriage classified by type of randomly allocated management method (expectant, medical, surgical)
None
Fig 2 Time (years) to live birth after index miscarriage classified by previous pregnancy (yes/no)
None
Fig 3 Time (years) to live birth after index miscarriage classified by maternal age
None
Fig 4 Time (years) to live birth after index miscarriage classified by previous miscarriages (0, 1, 2, ≥3)
See this image and copyright information in PMC

References

    1. Clayton SG. Gynaecology by ten teachers. Edward Arnold, 1989.
    1. Smith LFP. Should we intervene in uncomplicated miscarriage? BMJ 1993;306:1540-1. - PMC - PubMed
    1. Forbes K. Management of first trimester spontaneous abortions. BMJ 1995;310:1426. - PMC - PubMed
    1. Ankum WM, Van der Veen F. Management of first-trimester spontaneous abortion. Lancet 1995;345:1179. - PubMed
    1. Dickey RP. Management of uncomplicated miscarriage. Patients’ safe with expectant management. BMJ 1993;307:259. - PMC - PubMed

Publication types