Diagnosis and management of first trimester miscarriage

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f3676 (Published 19 June 2013)
Cite this as: BMJ 2013;346:f3676

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  1. Davor Jurkovic, consultant gynaecologist1,
  2. Caroline Overton, consultant gynaecologist2,
  3. Ruth Bender-Atik, national director3
  1. 1Department of Obstetrics and Gynaecology, University College Hospital, London NW1 2BU, UK
  2. 2St Michael’s University Hospital, Bristol, UK
  3. 3Miscarriage Association, Wakefield, UK
  1. Correspondence to: D Jurkovic davor.jurkovic{at}uclh.nhs.uk

Summary points

  • Miscarriage is the most common complication of pregnancy, affecting 12-24% of all pregnancies

  • Most early miscarriages are caused by chromosomal abnormalities, and the risk of miscarriage increases with maternal age

  • Transvaginal ultrasound is the best way to diagnose miscarriage

  • Most miscarriages resolve spontaneously and expectant management should be offered as the first line management strategy

  • Emergency surgery is indicated in women presenting with severe pain or bleeding and in those with signs of infection

  • Offer women and their partners access to counselling services, leaflets, web addresses, and helpline numbers for support organisations

Miscarriage is the most common complication of pregnancy. The reported rate of pregnancy loss in women with a missed menstrual period and positive urine pregnancy test is 12-24%.1 The true rate of miscarriage is probably higher because many losses occur preclinically, before a menstrual period is missed.2

About 125 000 miscarriages occur annually in the United Kingdom, resulting in 42 000 hospital admissions.3 Although miscarriages mostly resolve spontaneously without treatment and rarely cause severe maternal morbidity, the burden of disease is considerable, owing to the high incidence and associated costs of diagnostic investigations, hospital admission, surgical treatment, and follow-up. The loss of a pregnancy is often distressing for women and their partners, with adverse effects on their social and psychological wellbeing.

Reported UK maternal mortality rates after miscarriage in the period 1985 to 2008 range from 0.05 to 0.22 per 100 000 maternities.4 The most common causes of death were haemorrhage and sepsis, which tended to occur more often after second trimester losses.

Women with miscarriages are often treated conservatively in an outpatient setting, and general practitioners are often asked to advise women on the management options available to them and to provide support during follow-up. The aim of this review is to describe the diagnosis and …

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