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Intended for Healthcare Professionals
British Journal of General Practice

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Research Article

The natural course of spontaneous miscarriage: analysis of signs and symptoms in 188 expectantly managed women.

Margreet Wieringa-de Waard, Willem M Ankum, Gouke J Bonsel, Jeroen Vos, Petra Biewenga and Patrick J Bindels
British Journal of General Practice 2003; 53 (494): 704-708.
Margreet Wieringa-de Waard
Department of General Practice/Family Medicine, Academic Medical Center-University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands. m.wieringa@amc.uva.nl
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Willem M Ankum
Department of General Practice/Family Medicine, Academic Medical Center-University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands. m.wieringa@amc.uva.nl
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Gouke J Bonsel
Department of General Practice/Family Medicine, Academic Medical Center-University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands. m.wieringa@amc.uva.nl
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Jeroen Vos
Department of General Practice/Family Medicine, Academic Medical Center-University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands. m.wieringa@amc.uva.nl
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Petra Biewenga
Department of General Practice/Family Medicine, Academic Medical Center-University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands. m.wieringa@amc.uva.nl
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Patrick J Bindels
Department of General Practice/Family Medicine, Academic Medical Center-University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands. m.wieringa@amc.uva.nl
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Abstract

BACKGROUND: Expectant management is an alternative for curettage in women with a miscarriage. AIM: To assess the pattern of vaginal bleeding and pain in expectantly managed women with a miscarriage, and to analyse the factors predictive of a relatively quick spontaneous loss of pregnancy. DESIGN OF STUDY: Part of a study comparing expectant management with surgical evacuation. SETTING: Two hospitals in Amsterdam. METHOD: In expectantly managed women with a miscarriage, the pattern of vaginal bleeding and pain and the probability of a spontaneous loss of pregnancy was analysed. RESULTS: Of the 188 expectantly managed women 95 (51%) experienced a spontaneous loss of their pregnancy. In women with bleeding at inclusion, 52% had a completed miscarriage loss, while of the women without bleeding but with a coincidentally diagnosed non-viable pregnancy during routine ultrasonographic examination, 46% had a completed miscarriage. In the multivariate analysis an increasing bleeding pattern at inclusion was predictive of a relatively quick spontaneous loss of pregnancy. The median daily levels of bleeding and pain were the most prominent during the first 8 days after the start of the bleeding and decreased thereafter. CONCLUSIONS: Expectant management is effective in 51% of unselected women with a miscarriage. An increasing bleeding pattern is predictive of a relatively quick spontaneous loss of pregnancy in first-trimester miscarriages. The graphical representation of our findings can be used to inform women about the natural course of miscarriages and a well-informed treatment choice.

Supplementary Material

Supplementary table 1. Characteristics of expectantly managed women with and without bleeding at inclusion according to completed miscarriage, curettage on request or curettage as emergency procedure. Supplemental Figure 1
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British Journal of General Practice: 53 (494)
British Journal of General Practice
Vol. 53, Issue 494
September 2003
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The natural course of spontaneous miscarriage: analysis of signs and symptoms in 188 expectantly managed women.
Margreet Wieringa-de Waard, Willem M Ankum, Gouke J Bonsel, Jeroen Vos, Petra Biewenga, Patrick J Bindels
British Journal of General Practice 2003; 53 (494): 704-708.

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The natural course of spontaneous miscarriage: analysis of signs and symptoms in 188 expectantly managed women.
Margreet Wieringa-de Waard, Willem M Ankum, Gouke J Bonsel, Jeroen Vos, Petra Biewenga, Patrick J Bindels
British Journal of General Practice 2003; 53 (494): 704-708.
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Print ISSN: 0960-1643
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