Intended for healthcare professionals


Terminology for early pregnancy loss must be changed

BMJ 1998; 317 doi: (Published 17 October 1998) Cite this as: BMJ 1998;317:1081
  1. David J R Hutchon, Consultant obstetrician and gynaecologist.,
  2. Sandra Cooper, Chair of the Miscarriage Association.
  1. Department of Obstetrics and Gynaecology, Memorial Hospital, Darlington, Durham DL3 6HX

    Editorial p 1028

    EDITOR —Miscarriage is distressing, giving rise to a range of emotional experiences for both the woman and her partner. The aim of medical and nursing staff must be to reduce distress, but the distress may be increased by staff taking the wrong approach or using inappropriate terminology. The lay public tend to interpret an “abortion” as a termination of pregnancy.1 We advise that when women are counselled about miscarriage the word abortion should be avoided.

    The Royal College of Obstetricians and Gynaecologists has a study group on early pregnancy loss, which last year recommended new medical terminology that avoids the word abortion for spontaneous early pregnancy loss. The group suggests using the term “early fetal demise,”2 but women may still find this term distressing. “Delayed miscarriage”3 and “silent miscarriage”4 have been suggested to replace missed abortion. We carried out a search of Medline between January 1993 and November 1997 (table). We searched for the terms spontaneous abortion and miscarriage as textwords in two general medical British publications (British Medical Journal and The Lancet) and four specialist journals (British Journal of Obstetrics and Gynaecology, Journal of Obstetrics and Gynaecology, Ultrasound in Obstetrics and Gynaecology, and Fertility and Sterility).

    Results of Medline search (Jan 1993 to Nov 1997) of two general medical British journals and four specialist journals for articles that used either of two terms, “spontaneous abortion” and “miscarriage”

    View this table:

    This search showed that the word abortion is still widely used in the medical literature to describe spontaneous pregnancy loss. The British journals had a lower use of the word than the overall English language literature; perhaps surprisingly, the use was lower in general journals than specialist journals on reproduction. A suitable term to replace missed abortion may have slowed the change. While “delayed miscarriage” is not a complete description of the pathogenic process neither was “missed abortion.” For the purposes of medical classification, all miscarriages need further description to explain the underlying pathology, such as “anembryonic pregnancy.”

    Medical and nursing professionals may find it difficult to maintain one form of language for patients and another for medical notes. They should use the word miscarriage to describe all spontaneous pregnancy loss both when speaking to patients and when completing medical notes. The language culture cannot be changed without a change in the medical literature. Editors of medical journals should ensure that the word abortion is avoided when spontaneous pregnancy loss is meant. The problem seems to be confined to the English language. In French and German the medical words for termination of pregnancy and miscarriage are completely different.