Background and Aim: Recurrent pregnancy loss is present in 1-2% of all women. These women will sometimes experience “missed abortion”, where intervention is required. Danish guidelines currently recommend medical treatment of missed abortion rather than surgical treatment, but only a few studies have investigated which treatment women with recurrent pregnancy loss would prefer. This study aims to identify possible predictors for women preferring one method over the other and clarify the impact of side effects on the women’s treatment experiences.

Methods: Women referred to The Centre for Recurrent Pregnancy Loss of Western Denmark between January 2016 and September 2022, who had experienced both surgical and medical treatment for missed abortion, were sent a questionnaire regarding their experiences with the treatment methods (n = 157); 87 women submitted a response and were included in the study. The data was analyzed and compared using χ2 test and Wilcoxon Signed Rank Test and univariate analyses were conducted to determine possible associations.

Results: Significantly more women experienced a higher intensity of pain and had to take more pain killers after their first medical treatment for missed abortion compared to their first surgical treatment (p below 0.001 and p = 0.006). Bleeding, pain, prolonged sick leave, and mental discomfort had a significantly greater impact in women, who experienced a first medical abortion, in their choice of treatment method for their subsequent missed abortion. A reported failure rate for medical treatment of 44.8% was found. The odds ratio for preferring medical treatment was 3.3 if the women had given birth before (p = 0.011). The odds ratio for preferring medical treatment was 0.3, if the women had received medical treatment for their first missed abortion (p = 0.015). 66.7% of the women would prefer surgical treatment for their next missed abortion, while the remaining 33.3% would prefer medical treatment.

Conclusion: This study found that previous birth is a positive predictor for preferring medical treatment. However, the preference for surgical treatment of missed abortion, is twice as high as for medical treatment. This study found that, it is a negative predictor for preferring medical treatment, if the women received medical treatment for their first missed abortion. In our patient group medical treatment was also associated with a stronger experience of side effects and a high failure rate. These findings might be an explanation to why more women prefer surgical treatment and suggest, that current treatment recommendations should be reevaluated for women with missed abortion.