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
Divulgaciones
JD declares that she has no competing interests.
Agradecimientos
Dr Ida Muslim and Dr Jothi Doraiswamy would like to gratefully acknowledge Dr Isaac Babarinsa and Professor Tim Draycott, previous contributors to this topic.
Divulgaciones
IB and TD declare that they have no competing interests.
Revisores por pares
Jo Trinder, MD
Consultant Obstetrician and Gynaecologist
St Michael's Maternity Wing
Bristol Royal Infirmary
Bristol
UK
Divulgaciones
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
Divulgaciones
JB declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
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 Resumen
Tunçalp O, Gülmezoglu AM, Souza JP. Surgical procedures for evacuating incomplete miscarriage. Cochrane Database Syst Rev. 2010 Sep 8;(9):CD001993.Texto completo Resumen
Duckitt K, Qureshi A. Recurrent miscarriage. BMJ Clin Evid. 2015 [internet publication].
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Ectopic pregnancy/heterotopic pregnancy
- Hydatidiform mole
- Partial hydatidiform mole
Más DiferencialesGuías de práctica clínica
- Ectopic pregnancy and miscarriage: diagnosis and initial management
- ACR appropriateness criteria: abnormal uterine bleeding
Más Guías de práctica clínicaFolletos para el paciente
Miscarriage
More Folletos para el pacienteVideos
Miscarriage: experience of miscarriage
Miscarriage: discussing causal factors
Más videos
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