Expectant or Surgical Management of Miscarriage: A Qualitative Study

Thirteen women who presented to the Early Pregnancy and Gynaecology Assessment Unit of the authors’ institution with an incomplete miscarriage were offered the choice of surgical treatment or expectant management. The options were explained to the patients after ultrasound diagnosis. Five women each chose surgery and expectant management, and 3 tried expectant management but eventually underwent surgical treatment. An average of 5 weeks after the initial contact, the women were interviewed in depth about their experience. Women who chose expectant management expressed a desire to have a “natural” experience with natural healing, or they preferred to avoid surgery. Surgical treatment was chosen by women who were anxious to have the experience over with and who wanted to return to a normal life as quickly as possible. In both groups, some patients felt that they could have used more time and more information to make the treatment decision. Women in each group had similar experiences with bleeding and pain before coming to the early pregnancy unit, but women who opted for surgical management reported quick resolution of their symptoms (Table 1). Women who had expectant management reported continued heavy bleeding with severe pain. Some did not feel prepared for the experience. Three patients who chose expectant management decided to undergo surgery when the pain and bleeding continued. Both groups reported strong emotional support from family and friends, but some in the expectant management group said that support diminished after several days. Most patients who underwent surgery reported good emotional support from the hospital personnel.TABLE 1: Themes and categories