The physical and psychological effect of
miscarriage is commonly underappreciated. The journey from
diagnosis of
miscarriage, through clinical management, to supportive
aftercare can be challenging for
women, their partners, and
caregivers. Diagnostic challenges can
lead to delayed or ineffective care and increased
anxiety. Inaccurate
diagnosis of a
miscarriage can result in the unintended termination of a wanted
pregnancy.
Uncertainty about the
therapeutic effects of interventions can
lead to suboptimal care, with variations across facilities and countries. For this Series
paper, we have developed recommendations for practice from a
literature review, appraisal of guidelines, and expert group discussions. The recommendations are grouped into three categories (1)
diagnosis of
miscarriage, (2) prevention of
miscarriage in
women with early
pregnancy bleeding, and (3) management of
miscarriage. We recommend that every country
reports annual aggregate
miscarriage data, similarly to the
reporting of
stillbirth. Early
pregnancy services need to focus on providing an effective ultrasound service, as it is central to the
diagnosis of
miscarriage, and be able to provide
expectant management of
miscarriage, medical management with
mifepristone and
misoprostol, and surgical management with manual
vacuum aspiration.
Women with the dual
risk factors of early
pregnancy bleeding and a
history of previous
miscarriage can be recommended vaginal micronised
progesterone to improve the prospects of livebirth. We urge
health-care funders and providers to invest in early
pregnancy care, with specific focus on
training for
clinical nurse specialists and doctors to provide comprehensive
miscarriage care within the setting of dedicated early
pregnancy units. (AU)