Last reviewed: October 2018
Last updated: August  2018

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

Risk factors

  • older age
  • uterine malformation
  • bacterial vaginosis
  • thrombophilia
  • parental chromosomal anomaly
  • 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

  • urine pregnancy test
  • CBC
  • rhesus blood group
  • serum beta hCG titers
  • transvaginal ultrasound scan
Full details

Investigations to consider

  • transabdominal ultrasound scan
  • serum progesterone
  • lupus anticoagulant/anticardiolipin antibodies
  • pelvic ultrasound
  • cytogenetic analysis on products of conception
  • parental karyotype
  • vaginal swab
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant Obstetrician & Gynaecologist

The Women’s Centre

Gloucestershire Royal Hospital

Gloucester

UK

Disclosures

IM declares that she has no competing interests.

Locum Consultant in Obstetrics and Gynaecology

Gloucestershire Royal Hospital

Gloucester

UK

Disclosures

JD declares that she has no competing interests.

Dr Ida Muslim and Dr Jothi Doraiswamy would like to gratefully acknowledge Dr Isaac Babarinsa and Professor Tim Draycott, previous contributors to this topic. IB and TD declare that they have no competing interests.

Peer reviewers VIEW ALL

Consultant Obstetrician and Gynaecologist

St Michael's Maternity Wing

Bristol Royal Infirmary

Bristol

UK

Disclosures

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.

Consultant in Family Medicine

Parker D Sanders and Isabella Sanders Professor of Primary Care

Rochester

MN

Disclosures

JB declares that he has no competing interests.

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