Summary
Definition
History and exam
Key diagnostic factors
- vaginal bleeding with or without clots
Other diagnostic factors
- suprapubic pain
- low back pain
- recent postcoital bleed
- uterine structural abnormality
- history of trauma
Risk factors
- 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
Diagnostic investigations
1st investigations to order
- transvaginal ultrasound scan
- serum beta hCG titers
Tests to avoid
- inherited thrombophilia test
Investigations to consider
- 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
Treatment algorithm
threatened miscarriage
inevitable/incomplete/missed miscarriage
complete miscarriage
recurrent miscarriage
Contributors
Authors
Ida Muslim, MBChB, MRCOG
Consultant Obstetrician & Gynaecologist
The Women’s Centre
Gloucestershire Royal Hospital
Gloucester
UK
Disclosures
IM declares that she has no competing interests.
Jothi Doraiswamy, MBBS, MRCOG
Consultant in Obstetrics and Gynaecology
Gloucestershire Royal Hospital
Gloucester
UK
Disclosures
JD declares that she has no competing interests.
Acknowledgements
Dr Ida Muslim and Dr Jothi Doraiswamy would like to gratefully acknowledge Dr Isaac Babarinsa and Professor Tim Draycott, previous contributors to this topic.
Disclosures
IB and TD declare that they have no competing interests.
Peer reviewers
Jo Trinder, MD
Consultant Obstetrician and Gynaecologist
St Michael's Maternity Wing
Bristol Royal Infirmary
Bristol
UK
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
MN
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
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
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