***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Expectant and surgical management are widely accepted treatment options in case of a miscarriage . In the absence of differences in complications , the choice between both options can be based on patient preferences . STUDY DESIGN AND SETTING We studied treatment preferences for future miscarriages in women with a miscarriage r and omized to expectant or surgical treatment or managed according to their own choice .  RESULTS Data from 136 patients were analyzed . Women r and omized either to expectant or surgical management opted for the allocated treatment in future in 55 and 74 % , respectively . Of the women r and omized to expectant management and with a successful spontaneous loss , 71 % opted again for this treatment . Women who were managed according to their own treatment choice , held on to their initial treatment preference  ( expectant vs. surgical management ; 84 and 88 % , respectively ) . Preferences after treatment were strong . CONCLUSION A strong treatment preference should be taken into account in the counseling process . Women without a preference should be well informed on all medical aspects of the two options in order to facilitate informed-shared decision-making BACKGROUND In many countries , surgical uterine evacuation is the st and ard treatment for women with a miscarriage , but expectant management has been advocated as an alternative . The choice between the two options can not be based on published evidence alone , because r and omized clinical trials are scarce while generalizability of findings to patients with a strong preference for either management options is unclear . METHODS In a r and omized controlled trial , the complications and efficacy of either expectant or surgical management for miscarriages were compared , and the results in patients who refused r and omization and were managed according to their own preference were studied . In total , 122 patients were r and omized and 305 were managed according to their choice . RESULTS No differences were found in the number of emergency curettages and complications between expectant and surgical management .  Efficacy at 6 weeks was 30/64 ( 47 % ) in women allocated to expectant management , and 55/58 ( 95 % ) in women allocated to surgical evacuation . After 7 days , 37 % of expectantly managed women had a spontaneous complete miscarriage . After 6 weeks , intention-to-treat analysis including cross-overs showed similar effectiveness ( 92 % versus 100 % ) . Results in the preference groups were comparable with those in the r and omized groups . CONCLUSION In our experience a waiting period of 7 days after diagnosis may prevent 37 % of surgical procedures Objectives To compare fertility rates after the three methods of managing early miscarriage in women recruited to the MIST ( miscarriage treatment ) r and omised controlled trial . Setting Early pregnancy clinics of acute hospitals in the south west region of Engl and . Participants 1199 women who had had an early miscarriage ( < 13 weeks ) confirmed by scan . Intervention Expectant , medical , or surgical management . Main outcome measures Self reported pregnancy rates and live birth rates . Results Of 1199 women recruited to the trial , 1128 consented to follow-up . Of these , 762 women replied giving pregnancy details ( 68 % response rate ) . Respondents were representative of the trial participants . The live birth rate five years after the index miscarriage was similar in the three management groups : 177/224 ( 79 % , 95 % confidence interval 73 % to 84 % ) in the expectant management group , 181/230 ( 79 % , 73 % to 84 % ) in the medical group , and 192/235 ( 82 % , 76 % to 86 % ) in the surgical group . There was also no significant difference according to previous birth history . Older women and those with previous miscarriages were significantly less likely to subsequently give birth . Conclusion 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 . Women can be reassured that long term fertility concerns need not affect their choice of miscarriage management . Trial registration National Research Register N0467011677/N0467073587 Background : Medical management and expectant care have been considered possible alternatives to surgical evacuation of the uterus for first trimester spontaneous miscarriage in recent years Abstract Objective To ascertain whether a clinical ly important difference exists in the incidence of gynaecological infection between surgical management and expectant or medical management of miscarriage . Design R and omised controlled trial comparing medical and expectant management with surgical management of first trimester miscarriage . Setting Early pregnancy assessment units of seven hospitals in the United Kingdom . Participants Women of less than 13 weeks ' gestation , with a diagnosis of early fetal demise or incomplete miscarriage . Interventions Expectant management ( no specific intervention ) ; medical management ( vaginal dose of misoprostol preceded , for women with early fetal demise , by oral mifepristone 24 - 48 hours earlier ) ; surgical management ( surgical evacuation ) . Main outcome measures Confirmed gynaecological infection at 14 days and eight weeks ; need for unplanned admission or surgical intervention . Results 1200 women were recruited : 399 to expectant management , 398 to medical management , and 403 to surgical management . No differences were found in the incidence of confirmed infection within 14 days between the expectant group ( 3 % ) and the surgical group ( 3 % ) ( risk difference 0.2 % , 95 % confidence interval − 2.2 % to 2.7 % ) or between the medical group ( 2 % ) and the surgical group ( 0.7 % , − 1.6 % to 3.1 % ) . Compared with the surgical group , the number of unplanned hospital admissions was significantly higher in both the expectant group ( risk difference − 41 % , − 47 % to − 36 % ) and the medical group ( − 10 % , − 15 % to − 6 % ) . Similarly , when compared with the surgical group , the number of women who had an unplanned surgical curettage was significantly higher in the expectant group ( risk difference − 39 % , − 44 % to − 34 % ) and the medical group ( − 30 % , − 35 % to − 25 % ) . Conclusions The incidence of gynaecological infection after surgical , expectant , and medical management of first trimester miscarriage is low ( 2 - 3 % ) , and no evidence exists of a difference by the method of management . However , significantly more unplanned admissions and unplanned surgical curettage occurred after expectant management and medical management than after surgical management . Trial registration National Research Register : N0467011677/N0467073587 The aim of this prospect i ve study involving 39 women and 32 partners was to investigate the grief response of both the woman and her partner to miscarriage and to ascertain if support received was adequate and appropriate to their needs . Previous research shows that partners ' grief can often be delayed and chronic . Special emphasis is placed on this area in this study . The miscarriage was found to be a significant event and the majority of women and partners still experienced feelings of loss up to 4 months afterwards , describing their reactions as sad or very sad . Scores on the first administration of the Perinatal Grief Scale showed that , in contrast with previous findings , partners scored significantly higher than the women on the three subscales and overall . Partners ' scores on the second administration were also higher than those for the women but the difference was not significant . The women tended to receive and welcome social support more than the partners . Support received from health professionals was not always optimal , particularly for partners . Pregnancy subsequent to miscarriage was often viewed with some anxiety . It is argued that the results of the study have important implication s for health practice Early  pregnancy loss  is a profound adverse life event for many women , and increased psychiatric morbidity has been shown to occur after spontaneous abortion . Dilatation and curettage ( D&C ) has been the cornerstone in the treatment of first trimester spontaneous abortion over the last few decades . During recent years the possibility of conservative management has , however , been increasingly discussed . In a prospect i ve r and omized trial , we compared psychological reactions and morbidity , after either expectant management or D&C , for miscarriages of < 13 weeks gestation in which a transvaginal ultrasound examination showed intrauterine tissue and /or blood clots with an antero-posterior diameter of between 15 and 50 mm . Of the 86 patients included , 58 were r and omized to expectant management and 28 to primary D&C.  In patients r and omized to expectant management , pregnancy products shown by transvaginal ultrasound disappeared within 3 days in 43 cases ( 74 % ) , whereas 15 patients ( 26 % ) underwent D&C owing to retained products of conception after 3 days . At 2 weeks after inclusion , all patients answered self-administered question naires , including visual analogue scales , concerning their experience of the pregnancy loss , the present situation and concerns about the future . A brief anxiety status inventory was included . This study showed no increase in anxiety or depressive reactions 2 weeks after a first trimester spontaneous abortion when these patients were compared with non-pregnant healthy working females 19 - 39 years of age . Moreover , there were no significant differences in psychological reactions between patients managed either expectantly or by Approximately 15 % of registered pregnancies end in spontaneous abortion , and for 50 years or so dilatation and curettage ( D&C ) has been the usual management . In a prospect i ve r and omised trial we compared the clinical results after either expectant management or D&C , for miscarriages of less than 13 weeks ' gestation in which transvaginal ultrasound examination showed intrauterine tissue and /or blood clots with a diameter 15 - 50 mm . 103 patients were r and omised to expectant management and  spontaneous resolution of pregnancy occurred within 3 days in 81 cases ( 79 % ) . 52 patients were r and omised to D&C. 3 infections were diagnosed among patients who underwent expectant management ( 3 % ) ; 5 infections and 1 case of postoperative anaemia were observed among patients r and omised to D&C ( 11 % ) . The duration of vaginal bleeding was a mean of 1.3 days longer in the expectant management group ( p < 0.02 ) . Convalescence time , time during which patients experienced pain , and packed-cell volume 3 and 14 days after inclusion did not differ significantly between the groups . This study shows that expectant management of selected cases of spontaneous abortion has a similar outcome to Thirty‐five women with retained products of conception after spontaneous miscarriage were r and omised to expectant  ( n=19 ) or surgical  ( n=16 ) management , respectively . Women were review ed at one week , two weeks and six months . There were no significant differences in the number of days of pain , bleeding , sick leave or return to normal periods . Nine of twelve women from the expectant group and six of nine from the surgical group who attempted to conceive did so by six months . All 16 women were satisfied with conservative management . This study provides further reassurance when considering expectant management for  spontaneous miscarriage  both in the short and medium term INTRODUCTION Incomplete miscarriage is often treated with surgical evacuation in Sri Lanka .  Expectant management , which is an alternative treatment , was assessed for efficacy and safety in a local setting . METHODS R and omised clinical trial of two treatment groups of expectant and surgical management  with 71 and 69 participants , respectively , was done at the University Gynaecology Unit of the Colombo North Teaching Hospital , Ragama , from December 2007 to July 2009 . Women with incomplete miscarriage at a period of amenorrhoea of < 14 weeks and retained products of conception of < 50 mm were included .  Expectant management involved in-ward treatment till resolution of heavy bleeding and pain and follow up for two weeks . In surgical treatment , evacuation was undertaken and the patient sent home from hospital after bleeding settled with follow up . The maximum anteroposterior diameter of the endometrial cavity was measured with transvaginal ultrasonography and a diameter < 15 mm was considered as complete miscarriage . RESULTS Expectant management had a treatment success of 90.1 % at one week and 94.4 % at two weeks . For surgical treatment this was 95.7 % . Infection was noted in one subject from the surgical group and none in the expectant group . Fall in the haemoglobin concentration in the two groups was clinical ly not significant . The expectantly managed group had a shorter hospital stay than the surgically managed group ( 1.58 vs 2.57 days , p = 0.008 ) . CONCLUSIONS Expectant management is an effective and safe alternative to surgical evacuation in management of incomplete miscarriage in the local setting . It relieves the burden on the healthcare provider by shortening the hospital stay and avoiding the need for evacuation of retained products of conception under anaesthesia OBJECTIVE To evaluate the safety , efficacy , and acceptability of an oral drug regimen of medical abortion compared with surgical abortion . MATERIAL S AND METHODS 500 women with amenorrhea < 56 days chose either surgical abortion or 600 mg of mifepristone ( RU-486 ) followed by 400 microg of misoprostol after 48 h. RESULTS Medical regimen had more side effects than surgical abortion , including bleeding , cramping , nausea and vomiting . Only fever was more frequent in the surgical method . The failure rates for medical abortion exceeded those for surgical abortion , 16.0 % vs. 4.0 % . The adolescents ' failure rate in the medical regimen group was only 1.7 % . Several failures on medical abortion were not true drug failures 
    Output:
    
Expectant management led to a higher risk of incomplete miscarriage , need for unplanned ( or additional ) surgical emptying of the uterus , bleeding and need for transfusion .
Costs were lower for expectant management .