Sporadic miscarriage: evidence to provide effective care
File(s)THELANCET-D-20-14735 v4.1-clean.docx (269.25 KB)
Accepted version
Author(s)
Type
Journal Article
Abstract
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.
Date Issued
2021-05-01
Date Acceptance
2021-02-16
Citation
The Lancet, 2021, 397 (10285), pp.1668-1674
ISSN
0140-6736
Publisher
Elsevier
Start Page
1668
End Page
1674
Journal / Book Title
The Lancet
Volume
397
Issue
10285
Copyright Statement
© 2021 Published by Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/33915095
PII: S0140-6736(21)00683-8
Grant Number
RDD03 79560
RDD03 79560
Subjects
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
PREGNANCY ASSESSMENT UNIT
EMERGENCY-DEPARTMENT
RANDOMIZED-TRIAL
VAGINAL PROGESTERONE
MANAGEMENT
WOMEN
ULTRASOUND
IMPACT
ABORTION
DYDROGESTERONE
11 Medical and Health Sciences
General & Internal Medicine
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2021-04-27