Miscarriage in the first trimester affects about 15% of all pregnancies. It can be classified into early fetal loss (previously called missed abortion or blighted ovum) and retained products of conception (previously called incomplete abortion). Traditionally, both types of first trimester miscarriage are treated by surgical uterine evacuation. Increasingly, however, women are offered medical management (using misoprostol) or expectant management (avoiding treatment and letting the miscarriage take its natural course).

There have been numerous studies of miscarriage management, but they have generally been underpowered to assess anything other than the need for unplanned uterine curettage.12 The miscarriage treatment (MIST) study, a large, multicentre, randomised trial reported by Trinder and colleagues on p 1235, is therefore welcome.3

In the MIST study 1200 women with early fetal loss or retained products of conception were randomly allocated to receive expectant, surgical, or medical management. The primary outcome was infection, and there was no significant difference between the three groups when judged according to strict criteria. Women in the surgical group were, however, given significantly more prescriptions of antibiotics for …