expectant management of miscarriage

Last edited 09/2023 and last reviewed 09/2023

Expectant management of miscarriage

Expectant management allows spontaneous passage of retained products of conception without any interventions (1).

It can be offered to selected patients with a confirmed first trimester miscarriage (2).

Expectant management is particularly successful in incomplete miscarriage when compared to other types of miscarriages. According to a review based on multiple cohort studies, expectant management was successful within 2-6 weeks without increasing complications in:

  • 80-90% of women with incomplete spontaneous miscarriage
  • 65-75% of women with delayed miscarriage or an empty sac (3).

Patients undergoing expectant management should be ready to have surgical evacuation in case of failed conservative management.

NICE state:

Use expectant management for 7 to 14 days as the first-line management strategy for women with a confirmed diagnosis of miscarriage. Explore management options other than expectant management if:

  • the woman is at increased risk of haemorrhage (for example, she is in the late first trimester) or
  • she has previous adverse and/or traumatic experience associated with pregnancy (for example, stillbirth, miscarriage or antepartum haemorrhage) or
  • she is at increased risk from the effects of haemorrhage (for example, if she has coagulopathies or is unable to have a blood transfusion) or
  • there is evidence of infection

Medical management should be offered to women with a confirmed diagnosis of miscarriage if expectant management is not acceptable to the woman.

Offer a repeat scan if after the period of expectant management, the bleeding and pain:

  • have not started (suggesting that the process of miscarriage has not begun) or
  • are persisting and/or increasing (suggesting incomplete miscarriage)

Review the condition of a woman who opts for continued expectant management of miscarriage at a minimum of 14 days after the first follow-up appointment

For detailed guidance then see full guideline (4).