Miscarriage, the loss of a pregnancy before viability (commonly defined as before 24 weeks in the UK, and earlier in some countries), is common: around 1 in 5 recognised pregnancies end in miscarriage, most in the first trimester. Many women describe feeling dismissed or isolated after a loss. Nurses and midwives can make a lasting difference through skilled clinical care and compassion.
Types
| Type | Features |
|---|---|
| Threatened | Bleeding, cervix closed, pregnancy continuing; many go on normally |
| Inevitable | Bleeding and pain with the cervix open |
| Incomplete | Some pregnancy tissue passed, some remains |
| Complete | All tissue passed; bleeding and pain settling |
| Missed (silent) | Pregnancy has stopped developing but has not been passed; often found on scan |
| Septic | Infection of retained tissue: fever, offensive discharge, pain. An emergency |
Assessment
- Vital signs: look for signs of shock (rising pulse, falling BP) and sepsis (fever, fast breathing).
- Amount of bleeding (pads soaked per hour), passage of clots or tissue, pain.
- Always consider ectopic pregnancy, especially with one-sided pain or shoulder tip pain.
- Ultrasound and blood tests (full blood count, blood group, hCG) as available.
Management options
For stable women, the options are discussed and the woman chooses where clinically appropriate:
- Expectant: waiting for the pregnancy to pass naturally, with pain relief and clear follow-up.
- Medical: medicines such as misoprostol (often after mifepristone for missed miscarriage) to help the uterus empty.
- Surgical / uterine evacuation: manual vacuum aspiration (MVA), which WHO recommends over sharp curettage, often under local anaesthetic.
Heavy bleeding with shock, or septic miscarriage, needs emergency resuscitation, IV antibiotics as prescribed, and urgent evacuation of the uterus.
Post-abortion care
In many countries, complications from unsafe abortion are a significant cause of maternal death, and women with complications may arrive fearful of judgement. WHO’s post-abortion care model includes emergency treatment, family planning counselling and services, and links to other health services. Every woman deserves non-judgemental, confidential care, whatever the circumstances of her pregnancy loss.
Danger signs to teach before discharge
- Very heavy bleeding (soaking more than two pads an hour for two hours).
- Fever, chills, or foul-smelling discharge.
- Severe or worsening abdominal pain.
- Dizziness or fainting.
Rhesus status and follow-up
- Check blood group; follow local policy on anti-D for Rhesus-negative women.
- Arrange follow-up or a pregnancy test as advised to confirm completion.
- Offer family planning: fertility can return within two weeks.
- Women with recurrent miscarriage (three or more in a row in many guidelines; two in some) should be referred for investigation.
Compassionate communication
- Use the woman’s own words: many say “my baby”. Avoid clinical terms like “products of conception” in conversation.
- Acknowledge the loss: “I’m so sorry.”
- Reassure her that miscarriage is usually caused by chromosomal problems and is not caused by anything she did, such as working, exercise or sex.
- Offer privacy, and care away from women with ongoing pregnancies where possible.
- Ask about cultural or religious wishes regarding pregnancy remains.
- Remember partners grieve too.
- Watch for anxiety, depression or post-traumatic stress, and offer information about support.
Based on WHO abortion care guideline (2022), WHO post-abortion care guidance and NICE NG126 (Ectopic pregnancy and miscarriage). Educational content: follow national laws and guidelines.