Management following spontaneous first-trimester miscarriage involves expectant, medical, or surgical treatment. Which method is associated with the highest subsequent pregnancy rate is unclear. Researchers randomized 1199 women (mean age, 31) in England who experienced first-trimester (<13 weeks' gestation) index miscarriages between 1997 and 2001 to surgical evacuation, medical treatment (mifepristone, misoprostol, or both), or expectant management. From 2005 to 2007, follow-up questionnaires were sent to participants and their physicians about miscarriage management methods and subsequent pregnancies and live births.
Having experienced a previous miscarriage predicted lower fertility: 85% of women with no prior miscarriages delivered live infants versus 74%, 67%, and 58% of women with 1, 2, or 3 previous miscarriages, respectively. Older maternal age also predicted lower fertility and longer times before subsequent births. Among women who had experienced index miscarriages, about 80% had given birth within 5 years, regardless of miscarriage treatment method (79%, 79%, and 82% for expectant, medical, and surgical management, respectively).
