Key Takeaways
- Globally, an estimated 15-20% of all recognized pregnancies end in miscarriage.
- In the United States, about 10% of known pregnancies miscarry, but the true rate may be 25-50% including unrecognized ones.
- Miscarriage occurs in approximately 1 in 4 pregnancies worldwide.
- In the US, Black women have a 43% higher miscarriage risk than White women.
- Maternal age over 35 increases miscarriage risk to 20-35%.
- Previous miscarriage history doubles the risk of future miscarriages.
- Chromosomal abnormalities account for 50-70% of first-trimester miscarriages.
- Trisomy 16 is the most common chromosomal anomaly in miscarriages at 6-7%.
- Monosomy X (Turner syndrome) causes 15-20% of spontaneous abortions.
- Vaginal bleeding in first trimester present in 25% of pregnancies, 50% miscarry.
- Cramping abdominal pain occurs in 50-70% of symptomatic miscarriages.
- Passage of tissue or heavy bleeding signals complete miscarriage in 30% cases.
- Aspirin + heparin reduces miscarriage by 54% in APS patients.
- Progesterone supplementation cuts risk by 15% in high-risk women.
- Cervical cerclage prevents 30% of preterm losses in incompetent cervix.
Miscarriage is a sadly common, yet deeply personal global experience.
Causes
- Chromosomal abnormalities account for 50-70% of first-trimester miscarriages.
- Trisomy 16 is the most common chromosomal anomaly in miscarriages at 6-7%.
- Monosomy X (Turner syndrome) causes 15-20% of spontaneous abortions.
- Triploidy represents 15% of chromosomally abnormal miscarriages.
- Maternal genetic translocations cause 2-5% of recurrent miscarriages.
- Listeria monocytogenes infection linked to 20% of second-trimester losses.
- Rubella virus causes miscarriage in 20-50% of first-trimester infections.
- Cytomegalovirus (CMV) primary infection leads to 30% fetal loss.
- Parvovirus B19 associated with 5-10% miscarriage rate in acute infection.
- Uncontrolled hypothyroidism causes 17% higher miscarriage rate.
- Hyperhomocysteinemia (>13 µmol/L) doubles miscarriage risk via thrombosis.
- Uterine septum anomalies cause 15-20% of recurrent miscarriages.
- Bicornuate uterus increases late miscarriage risk by 25%.
- Asherman syndrome leads to 40% pregnancy loss rate post-hysteroscopy.
- Cervical incompetence causes 25% of second-trimester miscarriages.
- Placental abruption accounts for 10-15% of early losses.
- Blighted ovum (anembryonic pregnancy) in 50% of missed miscarriages.
- Molar pregnancy (hydatidiform mole) occurs in 1 in 1,000 pregnancies leading to miscarriage.
- Fetal growth restriction due to single umbilical artery raises loss risk by 20%.
- Turner syndrome mosaicism in 10% of miscarriages.
- Paternal aneuploidy contributes 4% via sperm.
- Zika virus causes 10-15% miscarriage in infected pregnancies.
- Toxoplasmosis acute infection leads to 10% loss.
- Group B Strep untreated +12% risk.
- Unruptured appendix increases risk 2-fold.
- MTHFR mutation (homozygous) raises risk 20% untreated.
- Arcuate uterus mild anomaly +15% risk.
- DES exposure in utero triples uterine anomalies/miscarriages.
- Amniotic band syndrome rare cause of 1% losses.
- Cord prolapse in second trimester 5% fatal.
- Subchorionic hematoma >50% size +22% risk.
Causes Interpretation
Incidence Rates
- Globally, an estimated 15-20% of all recognized pregnancies end in miscarriage.
- In the United States, about 10% of known pregnancies miscarry, but the true rate may be 25-50% including unrecognized ones.
- Miscarriage occurs in approximately 1 in 4 pregnancies worldwide.
- In the UK, around 1 in 8 known pregnancies miscarry.
- Early miscarriages (before 12 weeks) account for 80% of all pregnancy losses.
- The miscarriage rate after a positive pregnancy test is about 15-20%.
- In Europe, the overall miscarriage rate is estimated at 11-15% of clinical pregnancies.
- Australia reports a miscarriage rate of 15.3% for women aged 20-24.
- In India, miscarriage rates can reach 20-25% in rural areas due to limited healthcare.
- Canada sees about 15-20% of confirmed pregnancies end in miscarriage.
- Brazil has a reported miscarriage incidence of 12-18% among urban populations.
- In China, the miscarriage rate is approximately 12.5% for first pregnancies.
- South Africa reports 17% miscarriage rate in public health facilities.
- Japan has a low miscarriage rate of 9-10% due to advanced prenatal care.
- Russia estimates 13% of pregnancies miscarry before 12 weeks.
- Nigeria faces up to 30% miscarriage rates in low-resource settings.
- In France, the miscarriage rate is 10-15% of diagnosed pregnancies.
- Germany reports 14% early pregnancy loss rate.
- Italy sees 12.5% miscarriage incidence nationally.
- Spain has a 11.4% miscarriage rate per clinical pregnancy.
- In the US, miscarriage rates rise from 9% at age 20-29 to 53% at age 45.
- Europe-wide, 25% of pregnancies end before 6 weeks undetected.
- Mexico reports 18% miscarriage rate in first trimester.
- In Sweden, miscarriage registry shows 12.8% rate.
- Egypt has 22% rate influenced by consanguinity.
Incidence Rates Interpretation
Prevention/Treatment
- Aspirin + heparin reduces miscarriage by 54% in APS patients.
- Progesterone supplementation cuts risk by 15% in high-risk women.
- Cervical cerclage prevents 30% of preterm losses in incompetent cervix.
- Folic acid 400mcg daily reduces neural tube defects but miscarriage by 10%.
- Smoking cessation lowers risk to baseline within 1 year.
- Weight loss pre-pregnancy in obese women reduces risk by 20%.
- Thyroid screening and treatment halves miscarriage rate in subclinical hypo.
- Limit caffeine to <200mg/day prevents 14% excess risk.
- Avoid alcohol completely to eliminate 25% attributable risk.
- Bed rest ineffective, but pelvic rest advised in threatened miscarriage.
- Misoprostol induces expulsion in 84% of medical management cases.
- Expectant management succeeds in 50% within 2 weeks.
- Surgical evacuation has 99% complete evacuation rate.
- After one miscarriage, 85% chance of live birth next pregnancy.
- After two miscarriages, live birth rate 75% without intervention.
- Three miscarriages drop live birth to 50% untreated.
- Paternal factor testing recommended after 2 losses, finds 4% abnormalities.
- Hysteroscopy before next pregnancy improves live birth by 40% in RM.
- Multivitamins with B12 reduce risk by 22% in early pregnancy.
- 80% of couples achieve live birth within 2 years post-miscarriage.
- Levothyroxine normalizes TSH, cuts risk 70%.
- LMWH in thrombophilia reduces RM by 36%.
- IVF with PGS reduces aneuploid miscarriage by 50%.
- Mediterranean diet lowers risk 40% preconception.
- Exercise 150min/wk reduces risk 15%.
- Metformin in PCOS halves early loss.
- IVIG controversial, no benefit in RM trials.
- Alloimmune therapy not recommended, <10% efficacy.
- Genetic counseling post-2 RM finds 5% heritable.
- Laparoscopic myomectomy reduces risk 30% fibroids.
- Metroplasty for septum improves 80% live birth.
- Post-miscarriage counseling prevents 20% PTSD.
Prevention/Treatment Interpretation
Risk Factors
- In the US, Black women have a 43% higher miscarriage risk than White women.
- Maternal age over 35 increases miscarriage risk to 20-35%.
- Previous miscarriage history doubles the risk of future miscarriages.
- Smoking during pregnancy raises miscarriage risk by 20-30%.
- Obesity (BMI >30) increases miscarriage risk by 29%.
- Diabetes (pre-gestational) elevates risk by 1.5-2 times.
- Thyroid disorders increase miscarriage risk by 60%.
- Uterine fibroids raise risk by 14-27% depending on size/location.
- Polycystic ovary syndrome (PCOS) associated with 30-50% higher risk.
- Lupus (SLE) patients have 15-20% miscarriage rate per pregnancy.
- Antiphospholipid syndrome triples the miscarriage risk.
- Caffeine intake >200mg/day increases risk by 14%.
- Alcohol consumption raises risk by 25% with moderate use.
- Illicit drug use (cocaine) increases risk up to 40%.
- Advanced paternal age (>40) increases risk by 28%.
- Multiple pregnancies (twins) have 25% miscarriage rate.
- IVF pregnancies have 15-25% higher miscarriage risk than natural.
- Ectopic pregnancy history increases recurrent risk by 10%.
- Low progesterone levels (<10 ng/mL) predict 60% miscarriage risk.
- Advanced maternal age 40+ has 40% miscarriage risk.
- Nulliparity increases risk by 1.5 times vs multiparous.
- Hypertension doubles miscarriage risk in first trimester.
- Asthma uncontrolled raises risk by 25%.
- Endometriosis associated with 35% higher risk.
- Rheumatoid arthritis increases risk by 1.4-fold.
- Sickle cell disease elevates risk to 20-30%.
- HIV untreated increases miscarriage by 15%.
- Short interpregnancy interval <6 months raises risk 40%.
- High stress (PSS>20) linked to 42% higher risk.
- Shift work disrupts circadian rhythm, +20% risk.
- Radiation exposure >5mSv doubles risk.
- Air pollution (PM2.5>25µg/m3) +11% risk.
- Heavy metals (lead>5µg/dL) increase by 50%.
Risk Factors Interpretation
Symptoms/Diagnosis
- Vaginal bleeding in first trimester present in 25% of pregnancies, 50% miscarry.
- Cramping abdominal pain occurs in 50-70% of symptomatic miscarriages.
- Passage of tissue or heavy bleeding signals complete miscarriage in 30% cases.
- Ultrasound showing no fetal heartbeat before 7 weeks diagnoses miscarriage in 95% accuracy.
- hCG levels that plateau or drop >50% confirm miscarriage in 99% cases.
- Missed miscarriage (no symptoms) found in 1-5% of routine scans.
- Threatened miscarriage with closed cervix has 90% success rate to term.
- Inevitable miscarriage diagnosed by dilated cervix in 20% first-trimester losses.
- Incomplete miscarriage requires D&C in 50% of surgical management cases.
- Septic miscarriage presents with fever in 5% of untreated cases.
- Serial beta-hCG monitoring useful in 80% of inconclusive ultrasounds.
- Yolk sac absence before 5.5 weeks predicts miscarriage with 100% specificity.
- Crown-rump length <7mm with no heartbeat confirms anembryonic gestation.
- Progesterone <5 ng/mL in first trimester predicts 77% miscarriage risk.
- Recurrent miscarriage defined as 3+ consecutive losses in 1-2% women.
- Embryo with heartbeat <100bpm at 6-7w predicts 25% loss.
- Open cervix >2cm diagnoses inevitable in 95%.
- Products of conception histology abnormal in 70%.
- 3D ultrasound detects anomalies missed by 2D in 20%.
- EMA (empty sac) sign definitive for anembryonic.
- Fetal demise with CRL>25mm no HB 100% diagnostic.
- Painless bleeding in molar pregnancy 40% presentation.
- Rh isoimmunization rare cause post-12w loss.
- DVP<2cm predicts loss in threatened 80%.
- Karyotyping of POC recommended in RM 50% yield.
Symptoms/Diagnosis Interpretation
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