An estimated 23 million miscarriages occur every year worldwide.

Introduction

Miscarriage refers to the loss of a pregnancy before viability. An estimated 23 million miscarriages occur every year worldwide. The pooled risk of miscarriage is 15.3% (95% confidence interval 12.5% to 18.7%) of all recognised pregnancies.1

Women and their partners who suffer miscarriage generally want to understand why the pregnancy loss occurred, what they can do to prevent miscarriage from happening again, what the chance is of a subsequent pregnancy resulting in a healthy baby and how to deal with the grief surrounding their loss. Women who suffer miscarriage may have experienced distressing physical symptoms and also be anxious regarding their onward care. Caregivers should neither normalise nor over-medicalise miscarriage care.

It is important to individualise care according to women’s and their partners’ needs and preferences. The needs of women who have suffered a single miscarriage are likely to be different to those who have suffered two or more miscarriages.

A model of care should balance the need for evidence-based management and supportive care for each couple but also consider the best use of health care resources.

We suggest health services structure care using a ‘graded model’ according to clinical needs.

Bullet point guidance

  1. Following the first miscarriage women should be:

o supported with online pre-conceptual advice;

o screened for risk factors, including anaemia and thyroid dysfunction; and

o referred to appropriate pre-conception services in case of medical co-morbidities.

  1. Following a second miscarriage women should be offered (1) and a nurse- or midwifery-led service, ensuring continuity of care, appropriate investigations and ultrasound scanning for reassurance in a subsequent pregnancy.
  2. Following a third or subsequent miscarriage, women should be offered (1) and a consultant-led service with a full panel of investigations and interventions for recurrent miscarriage.

References

  1. Quenby S, Gallos ID, Dhillon-Smith RK, et al. Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. Lancet 2021; 397(10285): 1658-67.