Research Article Expectant Management of Miscarriage in View of NICE Guideline 154 Junaid Rafi and Haroona Khalil Ipswich Hospital NHS Trust Hospital, Heath Road Ipswich, IP4 5PD, UK Correspondence should be addressed to Junaid Raf; drjunaidraf@hotmail.com Received 27 November 2013; Revised 12 January 2014; Accepted 21 March 2014; Published 27 April 2014 Academic Editor: Fabio Facchinetti Copyright © 2014 J. Raf and H. Khalil. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. To fnd out the success rate of conservative management of complete two weeks for miscarriage in view of NICE Guideline 154. Design. Prospective observational study. Setting. Early pregnancy assessment units of District General Hospital in the United Kingdom. Participants. Women of less than 14 weeks’ gestation, with a diagnosis of miscarriage (missed miscarriage/anembryonic or incomplete miscarriage). Interventions. Expectant management for two weeks. Main Outcome Measure. (1) Efcacy of 2-week expectant management, that is, complete resolution of miscarriage based either on self-reporting of patient afer passing products of conception at home between D0 and D14 of expectant management or confrmation on scan at D14, and (2) short-term complications needing strong analgesia, blood transfusion, and antibiotics. Results. Expectant management of miscarriage for 2 weeks from the day of diagnosis was successful in 58% (64 /111) and failed in 42% (47/111). Conclusions. Expectant management success rate is consistent with the results from the longitudinal studies and RCTs published in the past. It is a safe option as none of the patients on expectant/medical management needed strong analgesia/antibiotics or blood transfusion. 1. Introduction Approximately 11–15% [1] of pregnancies result in sponta- neous frst-trimester miscarriage and for some women, it could be quite traumatic experience physically as well as psychologically. Many women want to get over it and there- fore are quite keen on active management; either medical or surgical; however, a sizeable percentage seems keen to explore conservative option of wait-and-see approach. Te new NICE 154 Guideline recommends expectant management for 7–14 days as the frst-line management strategy for miscarriage to explore management options other than expectant man- agement if the woman is at increased risk of haemorrhage and had history of stillbirth, miscarriage, or ante partum haemorrhage in previous pregnancy; for example, a history of stillbirth, miscarriage or ante partum haemorrhage in previous pregnancy; coagulopathies; unable to have a blood transfusion or if there is evidence of infection. We aimed to fnd out the success rate of conservative management of complete two weeks for miscarriage. 2. Material and Method We conducted this prospective longitudinal study from August 2012 to June 2013 in District General Hospital setting. Te NICE Guideline 154 was published in December 2012; however, we started collecting data in our Early Pregnancy Assessment Unit (EPAU) for this study since August 2012 when the draf version of NICE Guideline 154 was available online. Over a ten months period, 130 cases were diagnosed as missed miscarriage, out of which 111 agreed for expectant management afer counselling. We categorised miscarriage based on the ultrasound fnding into missed miscarriage (MMC)/anembryonic pregnancy and incomplete miscar- riage. For accuracy and uniformity, we calculated gestation by ultrasound measurements as well rather than from last menstrual period alone. We advised patients to inform us if they thought they had a completed miscarriage by noticing resolution of symptoms while being in the community before two weeks and were further instructed to do urine pregnancy test in two to three weeks’ time. However if the process of Hindawi Publishing Corporation Journal of Pregnancy Volume 2014, Article ID 824527, 4 pages http://dx.doi.org/10.1155/2014/824527