BMA Claire Wand基金會資助本研究。East Somerset Research Consortium提供贊助與研究統合管理。研究作者皆宣告沒有相關財務關係。
BMJ. 2009;339:b3827.
Treatment Method After a Miscarriage Does Not Affect Subsequent Pregnancies
By Laurie Barclay, MD
Medscape Medical News
October 8, 2009 — After miscarriage, 4 of 5 women give birth within 5 years regardless of method of miscarriage management, according to the results of a randomized controlled trial reported in the October 9 Online First issue of the BMJ.
"For decades the standard treatment of women who experienced an early miscarriage was evacuation of retained products of conception," write Lindsay F.P. Smith, MD, FRCP, FRCGP, from East Somerset Research Consortium, Westlake Surgery, in West Coker, Somerset, United Kingdom, and colleagues. "This was increasingly questioned, and now women are usually offered expectant (watch and wait, no active intervention) and medical management as well....Little published evidence, however, has assessed the effect of management method on subsequent fertility — a key issue for women and those responsible for their care."
The goal of this study was to compare fertility rates after the 3 methods of managing early miscarriage in women enrolled in the MIST (miscarriage treatment) randomized controlled trial. At early pregnancy clinics of acute hospitals in southwest England, 1199 women who miscarried before 13 weeks of gestation, as confirmed by scan, were randomly assigned to expectant, medical, or surgical management. The primary endpoints of the study were self-reported pregnancy rates and live birth rates.
Of 1128 MIST participants who consented to follow-up, 762 replied to a request for pregnancy details (68% response rate), and these women were thought to be representative of the trial participants overall. Five years after the index miscarriage, all 3 groups had similar live birth rates: 177 of 224 in the expectant management group (79%; 95% confidence interval [CI], 73% - 84%), 181 of 230 in the medical group (79%; 95% CI, 73% - 84%), and 192 of 235 in the surgical group (82%; 95% CI, 76% - 86%).
Previous birth history did not significantly affect live birth rates at 5 years, but these were significantly lower in older women and in women with previous miscarriages.
"Method of miscarriage management does not affect subsequent pregnancy rates with around four in five women giving birth within five years of the index miscarriage," the study authors write. "Women can be reassured that long term fertility concerns need not affect their choice of miscarriage management."
Limitations of this study include response rate of 68% and the unlikely possibility that one management method might cause very early future losses that this type of questionnaire study might not detect.
"Our results confirm that women experiencing three or more miscarriages might have problems subsequently giving birth and thus need to be investigated for a recurrent cause," the study authors conclude. "Women can be reassured that after miscarriage their chance of a subsequent live birth is high, irrespective of management method. This information should complement the information that they might want to receive to enable them to choose which management method is personally preferable, bearing in mind the clinical and economic differences."
The BMA Claire Wand Fund supported this study. East Somerset Research Consortium provided sponsorship and research governance management for this study. The study authors have disclosed no relevant financial relationships.
