Objectives: To compare short- and long-term emotional response (grief, anxiety, depressive symptoms) to early miscarriage in women randomised to expectant management or misoprostol treatment, and to compare satisfaction with treatment.

Methods: We conducted a planned secondary analysis of prospectively collected data from a randomised controlled trial comparing expectant management with vaginal misoprostol treatment of early miscarriage. Main outcome measures were grief, anxiety, depressive symptoms and client satisfaction assessed by validated psychometric self-assessment instruments, i.e. Perinatal grief scale (PGS), Spielberger State-Trait Anxiety Inventory (STAI-S Form-Y), Montgomery-Åsberg Depression Rating Scale Self-report version (MADRS-S) and Client Satisfaction Questionnaire (CSQ-8). Four assessment points were used: day of randomisation, day when the miscarriage was judged to be complete, at 3 months and 14 months after complete miscarriage.

Results: 189 women were recruited. 94 women in the misoprostol group and 90 women in the expectant group were analysed. The response rates at 14 months was 65% in the misoprostol group and 49% in the expectantly managed group. Despite higher treatment success rate in the misoprostol group, levels of anxiety, grief, depression and client satisfaction were similar in the two groups. Psychological wellbeing was significantly more impaired at inclusion than when the miscarriage was judged to be complete. Anxiety was more common than depression: 30% had severe anxiety and 10% moderate-severe depressive symptoms at inclusion. After 14 months, one woman had scores indicating severe depression. Satisfaction with treatment was high. More than 85% of the participants would recommend the treatment they received to a friend.

Conclusions: The psychological response to and recovery after early miscarriage did not differ between women treated with misoprostol and those managed expectantly. Satisfaction with treatment was high in both treatment groups.