Immediate versus delayed medical treatment for first-trimester miscarriage: a randomized trial
A Torre
This randomized open-label trial compared immediate medical treatment of first-trimester miscarriage with delayed treatment after 1 week of watchful waiting. Delayed treatment led to worse outcomes, including more vacuum aspirations overall (43.5% vs 19.1%), more emergent aspirations, more unplanned emergency visits, and a longer time to complete evacuation. The study concludes that postponing medical treatment increases the likelihood of unplanned surgical intervention, so immediate medical treatment appears more effective than sequential expectant-then-medical management.