The medical management of missed miscarriage: outcomes from a prospective, single-centre, Australian cohort.

OBJECTIVE To report the prospective outcomes of medical management of missed miscarriage before 13 weeks' gestation from an Australian cohort. DESIGN Descriptive study of a cohort selected out of a randomised controlled trial. SETTING Outpatient management at a maternity hospital between 1 May 2007 and 28 July 2010. PARTICIPANTS 264 women requesting medical management of missed miscarriage. MAIN OUTCOME MEASURES Number of doses of misoprostol required, unscheduled visits for care, findings at ultrasound follow-up, requirement for surgical management, number of cases of gestational trophoblastic disease (GTD), and self-reported patient experience. RESULTS 107 women (40.5%) received a repeat dose of misoprostol, and 79 women (29.9%) made unscheduled visits for care. Among the 241 women with Day 7 ultrasound follow-up, a gestational sac was found in 32 women (13.3%), indicating failure of medical management. Complete miscarriage was induced without the need for surgery in 206 women (78.0%). Surgery was performed as an emergency in 13 women (4.9%). Twelve women (4.5%) had surgery for ongoing bleeding after medical management, and four of these did not have chorionic villi on histopathological examination. Five women (1.9%) had GTD, which was managed incidentally under the protocol. Among those who returned patient questionnaires, 73.0% participants (116/159) indicated that they would recommend medical management of miscarriage to other women, while 18.2% (29/159) indicated that they would undergo surgery next time. CONCLUSION The medical management of missed miscarriage on an outpatient basis is safe and effective. TRIAL REGISTRATION ACTRN12612000150842.