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Flashcards in MIST follow up Deck (11)
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1

Journal
year

BMJ 2009

2

Aims

To compare fertility rates after the 3 methods of managing early miscarriage in women

3

Study Design

RCT

4

Participants

- Early pregnancy clinics of acute hospitals in south west region of England
- 1199 women who had had an early miscarriage (<13/40) confirmed on scan
- 1128 consented to follow-up
- Of these 762 women replied giving pregnancy details (68% response rate)

5

Intervention

Expectant, medical, or surgical management

6

Primary end-points

Self reported pregnancy rates and live birth rates

7

Summary of results

- Live birth rates 5 years after the index miscarriage was similar in 3 management groups
o 79% expectant
o 79% medical
o 82% surgical
- No significant difference according to previous birth history
- Older women and those with previous miscarriages were significantly less likely to subsequently give birth

8

Limitations

- Sending out questionnaires (but responders were similar to initial trial demographic and still included women who did not want to conceive after index miscarriage)
- Only 68% response rate
- Relied on self-reporting of pregnancy

9

Conclusion

- Method of miscarriage management does not affect subsequent pregnancy rates
- 4 in 5 women giving birth within 5 years of index miscarriage
- Women can be reassured that long term fertility concerns need not affect their choice of miscarriage management

10

What is already known on this topic

- All 3 of the methods of management of early miscarriage currently offered to women in the UK and elsewhere are probably equivalent in terms of gynaecological infection
- Little published evidence has assessed the effect of management method on subsequent fertility – a key issues for women and those who care for them

11

What this study adds

- Type of management method does not affect subsequent fertility, with around 80% of women having a live birth within 5 years of the index miscarriage