Miscarriage

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Última revisão: 12 Aug 2025

Última atualização: 03 Feb 2023

Miscarriage occurs in up to one third of pregnancies.

Described as threatened, inevitable, incomplete, complete, missed, or recurrent miscarriage.

Presence of pain, hypotension, tachycardia, and/or anemia warrants exclusion of a life-threatening differential diagnosis such as an ectopic pregnancy.

Serial serum beta hCG titers and a transvaginal ultrasound scan aid in diagnosis.

Medical or surgical uterine evacuation is recommended when the pregnancy is no longer viable. The patient may also be offered a choice of conservative management unless there is profuse, heavy, and persistent bleeding.

The experience of a miscarriage is associated with a psychological impact of varying intensity in the short or long term, or both.

Definição

Miscarriage is an involuntary, spontaneous loss of a pregnancy before 20-24 completed weeks.[1] The gestational threshold for the definition varies between countries: in the US it is usually 20 weeks (but may vary in different states), whereas in the UK, the Royal College of Obstetricians and Gynaecologists defines it as 24 weeks.[2][3] After these differing cut-offs, the loss would be defined as a stillbirth. Miscarriage is associated with unprovoked vaginal bleeding with or without suprapubic pain. The commonly used term, abortion, is unpopular with women who are uncomfortable with a suggestion that it follows an intentional attempt to terminate the pregnancy.[4]

História e exame físico

Principais fatores diagnósticos

vaginal bleeding with or without clots

Detalhes completos

Outros fatores diagnósticos

suprapubic pain
low back pain
recent postcoital bleed
uterine structural abnormality
history of trauma

Detalhes completos

Fatores de risco

older age
uterine malformation
bacterial vaginosis
thrombophilia
parental chromosomal anomaly
vitamin D deficiency
previous spontaneous/induced miscarriage
infertility/assisted conception
nonsteroidal anti-inflammatory drugs (NSAIDs)
caffeine
alcohol
smoking
overweight/obesity
thyroid dysfunction
diabetes mellitus

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

transvaginal ultrasound scan
serum beta hCG titers

Detalhes completos

Tests to avoid

inherited thrombophilia test

Detalhes completos

Investigações a serem consideradas

transabdominal ultrasound scan
serum progesterone
urine pregnancy test
CBC
rhesus blood group
lupus anticoagulant, anticardiolipin antibodies, and anti-beta 2 glycoprotein I antibodies
pelvic ultrasound
cytogenetic analysis on products of conception
parental karyotype
vaginal swab

Detalhes completos

Algoritmo de tratamento

Inicial

threatened miscarriage

AGUDA

inevitable/incomplete/missed miscarriage

complete miscarriage

CONTÍNUA

recurrent miscarriage

Colaboradores

Autores

Ida Muslim, MBChB, MRCOG

Consultant Obstetrician & Gynaecologist

The Women’s Centre

Gloucestershire Royal Hospital

Gloucester

Declarações

IM declares that she has no competing interests.

Jothi Doraiswamy, MBBS, MRCOG

Consultant in Obstetrics and Gynaecology

Gloucestershire Royal Hospital

Gloucester

Declarações

JD declares that she has no competing interests.

Agradecimentos

Dr Ida Muslim and Dr Jothi Doraiswamy would like to gratefully acknowledge Dr Isaac Babarinsa and Professor Tim Draycott, previous contributors to this topic.

Declarações

IB and TD declare that they have no competing interests.

Revisores

Jo Trinder, MD

Consultant Obstetrician and Gynaecologist

St Michael's Maternity Wing

Bristol Royal Infirmary

Bristol

Declarações

JT is the primary author of one randomized controlled trial cited in this topic. This trial was funded by an NHS Research and Development Grant and a donation from Exelgyn, the manufacturer of misoprostol. JT has accepted honoraria for speaking to groups of midwives and doctors about miscarriage management.

John Bachman, MD

Consultant in Family Medicine

Parker D Sanders and Isabella Sanders Professor of Primary Care

Rochester

Declarações

JB declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

World Health Organization, UNICEF, United Nations Population Fund. Vaginal bleeding in early pregnancy. In: Managing complications in pregnancy and childbirth: a guide for midwives and doctors - 2nd edition. 2017 [internet publication].Texto completo

National Institute for Health and Care Excellence. Ectopic pregnancy and miscarriage: diagnosis and initial management. Nov 2021 [internet publication].Texto completo

European Society of Human Reproduction and Embryology. Guideline on the management of recurrent pregnancy loss. Nov 2017 [internet publication].Texto completo

American College of Obstetricians and Gynecologists. Practice bulletin: early pregnancy loss. Nov 2018 [internet publication].Texto completo

Kim C, Barnard S, Neilson JP, et al. Medical treatments for incomplete miscarriage. Cochrane Database Syst Rev. 2017 Jan 31;(1):CD007223.Texto completo Resumo

Tunçalp O, Gülmezoglu AM, Souza JP. Surgical procedures for evacuating incomplete miscarriage. Cochrane Database Syst Rev. 2010 Sep 8;(9):CD001993.Texto completo Resumo

Duckitt K, Qureshi A. Recurrent miscarriage. BMJ Clin Evid. 2015 [internet publication].

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Ectopic pregnancy/heterotopic pregnancy
- Hydatidiform mole
- Partial hydatidiform mole
Mais Diagnósticos diferenciais
Diretrizes
- Ectopic pregnancy and miscarriage: diagnosis and initial management
- ACR appropriateness criteria: abnormal uterine bleeding
Mais Diretrizes
Folhetos informativos para os pacientes
Miscarriage
Mais Folhetos informativos para os pacientes
Videos
Miscarriage: experience of miscarriage
Miscarriage: discussing causal factors
Mais vídeos
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Miscarriage

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Tests to avoid

Investigações a serem consideradas

Algoritmo de tratamento

threatened miscarriage

inevitable/incomplete/missed miscarriage

complete miscarriage

recurrent miscarriage

Colaboradores

Autores

Ida Muslim, MBChB, MRCOG

Declarações

Jothi Doraiswamy, MBBS, MRCOG

Declarações

Agradecimentos

Declarações

Revisores

Jo Trinder, MD

Declarações

John Bachman, MD

Declarações

Peer reviewer acknowledgements

Disclosures

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Videos

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice