Fifteen per cent of pregnancies
end in early miscarriage. For decades the standard management of early
miscarriage was surgical evacuation of retained products of conception. But
this was increasingly questioned and now women are usually offered expectant
(watch and wait) and medical management as well.
Previous studies, including the
largest published trial (the MIST trial), have suggested that all three methods
are probably equivalent in terms of gynaecological infection, but their long
term effects on fertility are not known.
So researchers based in the South
West of England compared fertility rates for the three management methods
(expectant, medical or surgical).
They surveyed 762 women who had
taken part in the original MIST study, and who had randomly received surgical,
medical or expectant management for an early miscarriage (less than 13 weeks
These women completed a
questionnaire about subsequent pregnancies and live births after this miscarriage.
The effects of age, previous miscarriage and previous birth history were taken
Among the survey respondents,
83.6% reported a subsequent pregnancy, with 82% having a live birth.
Time to subsequently giving birth
was very similar in the three management groups: 79% of those randomised to
expectant management, 78.7% of the medical group and 81.7% of the surgical
group all had a live birth five years after their miscarriage.
However, older women and those
suffering three or more miscarriages were significantly less likely to
subsequently give birth.
The authors conclude that method
of miscarriage management does not affect subsequent pregnancy rates, with
around four in five women having a live birth within five years of a miscarriage.
"Women can be reassured that long term fertility
concerns need not affect their choice of miscarriage, management method," they