Sporadic miscarriage: evidence to provide effective care

Area of Science:

• Obstetrics and Gynecology
• Reproductive Health
• Clinical Practice Guidelines

Background:

• The physical and psychological impact of miscarriage is often underestimated.
• Challenges in diagnosis, management, and aftercare affect women, partners, and caregivers.
• Variations in care quality exist across healthcare facilities and countries.

Purpose of the Study:

• To develop evidence-based recommendations for the diagnosis, prevention, and management of miscarriage.
• To address diagnostic challenges and improve the quality of early pregnancy care.
• To advocate for increased investment in comprehensive miscarriage services.

Main Methods:

• Literature review
• Appraisal of existing clinical guidelines
• Expert group discussions

Main Results:

• Recommendations cover diagnosis, prevention in early pregnancy bleeding, and management of miscarriage.
• Emphasis on effective ultrasound services and availability of expectant, medical (mifepristone/misoprostol), and surgical (manual vacuum aspiration) management.
• Vaginal micronized progesterone recommended for women with early pregnancy bleeding and prior miscarriage history to improve livebirth rates.

Conclusions:

• Countries should report annual aggregate miscarriage data.
• Investment in early pregnancy care, including training for healthcare professionals, is essential.
• Dedicated early pregnancy units can provide comprehensive miscarriage care.