Miscarriage

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 anaemia warrants exclusion of a life-threatening differential diagnosis such as an ectopic pregnancy.

Serial serum beta hCG titres and a trans-vaginal 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.

Miscarriage is an involuntary, spontaneous loss of a pregnancy before 20-24 completed weeks.[1]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]. http://www.who.int/maternal_child_adolescent/documents/managing-complications-pregnancy-childbirth/en 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]Centers for Disease Control and Prevention. What is stillbirth? Nov 2020 [internet publication]. https://www.cdc.gov/ncbddd/stillbirth/facts.html [3]Royal College of Obstetricians and Gynaecologists. The investigation and treatment of couples with recurrent miscarriage Green-top guideline no. 17. Apr 2011 [internet publication]. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg17  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]Hutchon DJ. Understanding miscarriage or insensitive abortion: time for more defined terminology? Am J Obstet Gynecol. 1998 Aug;179(2):397-8. http://www.ncbi.nlm.nih.gov/pubmed/9731844?tool=bestpractice.com