Table 7.3Additional findings evaluating expectant and active miscarriage management strategies

Qualitative data on emotional/psychological outcomes and women's satisfaction with management
1 study

(Smith et al., 2006)

Areas with general consensus:


There was near uniform fear of intervention, especially anaesthetic, and a perception of hospitalisation and surgery as traumatic events.

‘… I didn't really want to have anything done. I thought it was bad enough having lost it, without having to have any more fiddling around.’


Women wanted a predictable end, so they could get on with their lives, and they wanted their management and symptoms to have a predictable course.

‘And it was like: I wanted it done, I wanted it done now. I wanted to get home for tea, sort of thing, that was how I was: can't we just do it.’

Need for more information

Women felt they did not know what to expect in terms of bleeding and pain, and wanted more details on the timing, duration and effects of interventions.

‘I didn't want to sort of just go home and wait for a miscarriage, because I didn't know what to expect at all.’

Areas with wider variation in responses


Some women queried whether intervention was necessary and wished to be allowed to miscarry naturally themselves, whereas others were in favour of something being done to help expedite completion.

‘I didn't want a D & C, … I know it sounds silly, ‘cos the baby was already dead, but I don't agree with abortion, and things like that, and to me it felt the same; I wanted to do it on my own, and I got the D & C.’

‘I remember thinking about the three options, and coming to the conclusion that, at least a D & C was quick … because at the time I'd been off work for 3 weeks already … and I just thought: I don't want to wait anymore, particularly as I don't know what's going to happen.’

Awareness of the event

Some women felt benefit in experiencing the event, to allow them to say goodbye, whereas others preferred surgery to avoid consciousness of the miscarriage.

‘… it's very clean, very quick, wonderful operation, but, in a way, I think probably letting it miscarry helps to grieve in a funny way, because you're going through your grief all of the time that you are waiting for it to go, and then it goes, and you do a sort of mental realignment or whatever, you know, you have time to sort of prepare yourself.’

The ‘baby’

A few women wanted to see it and say goodbye, whereas others were scared about what they might see and wanted to avoid it. Some women wanted to avoid intervention because in the case of a misdiagnosis they felt that they would have been responsible for the baby's death.

‘… but you know, I just sort of thought: what's that there? You know and, then, sort of waited, and then when you pull the flush, it's like a real goodbye, you know.’

Pain and bleeding

Pain and bleeding were mentioned mostly by medical and expectant groups. Experiences of pain varied considerably, whereas bleeding was generally described as being a lot.

‘They said it would be like a contraction, but it wasn't like a contraction at all, really … it was like very strong period pain … I likened it to when I first started my periods, when I was 13.’

‘… I mean, looking back on it, I bled for about 40 hours, and had 40 hours of pain and bleeding; but I think that the actual psychological support I had was so much better, that it didn't seem that bad.’

Care received

A minority of women in the medical and surgical groups described a lack of caring by staff. In contrast, several women in the expectant group commented that although the experience was upsetting for them they found it reassuring to be at home.

‘… and I hated it! The whole thing was cold! It was so insensitive, it was horrible! I will never forget how insensitive and cold it felt.’ (woman who had surgical treatment)

‘… so, you know, I thought: no, I'll be at home, I'll be safe, and if there's any real problems, I've got a phone number to ring, or my GP, or we'll just call…’ (woman who chose expectant management)
Emotional and psychological outcomes in non-randomised women
1 study

(Wieringa-de Waard et al., 2002b)

(Very low*)
In addition to the randomised women (n = 82), this study reports the outcomes of women who chose to be managed according to their own preference (n = 147). Their outcomes are analysed separately, and in comparison with the randomised group.

Within the preference group, there were no statistically significant differences between the mental health scores and anxiety scores of women who chose expectant management (n = 61) and women who chose active treatment (n = 86).

Comparing randomised and non-randomised women

When comparing women who were randomised to expectant management and women who chose expectant management, there were no significant differences in mental health score and anxiety.

Women who were randomised to active treatment had significantly worse mental health scores than women who chose active treatment (P = 0.03).

Within the randomised group, no differences were found between women who were randomly allocated to the mode of management for which they had expressed a slight preference and those who were randomised to the other mode of management.


Other than expressing a strong preference for a specific management option, it is unclear whether randomised and non-randomised women were comparable. Mean values for all scores at different assessment times were not reported as figures in the text but only in graphs from which it is impossible to extract accurate values.

Qualitative studies not ranked in GRADE but using NICE quality assessment for qualitative studies

From: 7, Management of threatened miscarriage and miscarriage

Cover of Ectopic Pregnancy and Miscarriage
Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management in Early Pregnancy of Ectopic Pregnancy and Miscarriage.
NICE Clinical Guidelines, No. 154.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG; 2012 Dec.
Copyright © 2012, National Collaborating Centre for Women's and Children's Health.

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