Expectant or surgical management of miscarriage: a qualitative study

Objective  To explore women's reasons for selecting either expectant or surgical management of first trimester miscarriage and to examine the impact of treatment upon them.

Design  A qualitative study using interviews.

Setting  The Early Pregnancy and Gynaecology Assessment Unit at a London hospital.

Sample  Thirteen women diagnosed as having a first trimester miscarriage who had opted for either expectant management (n= 5), surgical management (n= 5) or who had undergone both (n= 3).

Methods  Qualitative in depth interviews.

Main outcome measures  The experience of management.

Results  The choice of expectant management was motivated by desire for a natural solution and a fear of operation. Women described how pain and bleeding had made them anxious, that something was wrong and how they felt unprepared for how gruelling the experience would be. Some also described how their support had dwindled as the miscarriage progressed. In contrast, women who chose surgery valued a quick resolution and focussed on the support from hospital staff, although some commented that their emotional needs had not always been met.

Conclusion  If expectant management is to be more widely offered, women should be told not only of the likely clinical effect of letting a miscarriage run its course but also how women experience this.