Expectant management of first-trimester spontaneous abortion

Lancet. 1995 Jan 14;345(8942):84-6. doi: 10.1016/s0140-6736(95)90060-8.


Approximately 15% of registered pregnancies end in spontaneous abortion, and for 50 years or so dilatation and curettage (D&C) has been the usual management. In a prospective randomised trial we compared the clinical results after either expectant management or D&C, for miscarriages of less than 13 weeks' gestation in which transvaginal ultrasound examination showed intrauterine tissue and/or blood clots with a diameter 15-50 mm. 103 patients were randomised to expectant management and spontaneous resolution of pregnancy occurred within 3 days in 81 cases (79%). 52 patients were randomised to D&C. 3 infections were diagnosed among patients who underwent expectant management (3%); 5 infections and 1 case of postoperative anaemia were observed among patients randomised to D&C (11%). The duration of vaginal bleeding was a mean of 1.3 days longer in the expectant management group (p < 0.02). Convalescence time, time during which patients experienced pain, and packed-cell volume 3 and 14 days after inclusion did not differ significantly between the groups. This study shows that expectant management of selected cases of spontaneous abortion has a similar outcome to D&C.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abortion, Spontaneous / complications
  • Abortion, Spontaneous / diagnostic imaging
  • Abortion, Spontaneous / therapy*
  • Convalescence
  • Dilatation and Curettage / adverse effects
  • Female
  • Humans
  • Pregnancy
  • Pregnancy Trimester, First
  • Prospective Studies
  • Ultrasonography, Prenatal