expectant management of miscarriage
Last edited 09/2023 and last reviewed 09/2023
Expectant management of miscarriage
Expectant management allows spontaneous passage of retained products of conception without any interventions (1).
It can be offered to selected patients with a confirmed first trimester miscarriage (2).
Expectant management is particularly successful in incomplete miscarriage when compared to other types of miscarriages. According to a review based on multiple cohort studies, expectant management was successful within 2-6 weeks without increasing complications in:
- 80-90% of women with incomplete spontaneous miscarriage
- 65-75% of women with delayed miscarriage or an empty sac (3).
Patients undergoing expectant management should be ready to have surgical evacuation in case of failed conservative management.
Use expectant management for 7 to 14 days as the first-line management strategy for women with a confirmed diagnosis of miscarriage. Explore management options other than expectant management if:
- the woman is at increased risk of haemorrhage (for example, she is in the late first trimester) or
- she has previous adverse and/or traumatic experience associated with pregnancy (for example, stillbirth, miscarriage or antepartum haemorrhage) or
- she is at increased risk from the effects of haemorrhage (for example, if she has coagulopathies or is unable to have a blood transfusion) or
- there is evidence of infection
Medical management should be offered to women with a confirmed diagnosis of miscarriage if expectant management is not acceptable to the woman.
Offer a repeat scan if after the period of expectant management, the bleeding and pain:
- have not started (suggesting that the process of miscarriage has not begun) or
- are persisting and/or increasing (suggesting incomplete miscarriage)
Review the condition of a woman who opts for continued expectant management of miscarriage at a minimum of 14 days after the first follow-up appointment
For detailed guidance then see full guideline (4).
- 1. Trinder J et al. Management of miscarriage: expectant, medical, or surgical? Results of randomised controlled trial (miscarriage treatment (MIST) trial). BMJ 2006;332:1235-1240
- 2. Royal College of Obstetricians and Gynaecologists (RCOG) 2006. The management of early pregnancy loss
- 3. Sagili H, Divers M. Modern management of miscarriage. The Obstetrician & Gynaecologist 2007;9:2:102-108
- 4 NICE (September 2023).Ectopic pregnancy and miscarriage: diagnosis and initial management