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Miscarriage (Early Pregnancy Loss)

Also known as: spontaneous abortion · early pregnancy loss · threatened/missed/incomplete miscarriage

Loss of a pregnancy before viability — bleeding and/or pain in early pregnancy. Types range from threatened (viable, closed os) to inevitable, incomplete, missed and complete. Exclude ectopic pregnancy in any early-pregnancy bleeding.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Common in early pregnancy; risk rises with maternal age, chromosomal abnormality, infection, and some uterine/medical conditions.

Red flags — escalate / refer

Heavy bleeding with instability, sepsis (offensive discharge, fever — septic miscarriage), or features of ectopic pregnancy (unilateral/shoulder-tip pain, collapse) → emergency.

Work-up / diagnosis

1Assess bleeding and haemodynamic stability; a pregnancy test and pelvic ultrasound (viability, retained products, and to EXCLUDE ectopic).
2A serum hCG trend where the scan is inconclusive; check blood group for anti-D where indicated.

Management — overview

Resuscitate heavy bleeding or sepsis first.
For confirmed miscarriage, offer expectant, medical (misoprostol, sometimes with mifepristone) or surgical management (uterine evacuation) according to the type and the woman's choice.
Give antibiotics for septic miscarriage and anti-D prophylaxis where indicated.
Provide emotional support and follow-up.

In-depthFull dosing & advanced protocol

Drug dosing

Misoprostol (± mifepristone)

Medical management of miscarriage

Adult dose: Per protocol by gestation and type
Route: Oral / vaginal / sublingual
Population: pregnancy

WHOWHO recommendations on antenatal care for a positive pregnancy experience (2016) ↗

Anti-D immunoglobulin (± antibiotics)

Rhesus-negative women where indicated; antibiotics for sepsis

Adult dose: Per protocol
Route: IM / IV

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Exclude ectopic; three valid options

Any bleeding in early pregnancy is ectopic until a scan proves otherwise.
Expectant, medical and surgical management are all valid — guided by type, bleeding and choice.
Septic miscarriage needs antibiotics plus evacuation; don't forget anti-D and psychological support.

WHOWHO recommendations on antenatal care for a positive pregnancy experience (2016) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

Antenatal CareStructured pregnancy care to keep mother and baby healthy — screening, supplementation, immunisation and danger-sign education across scheduled contacts.Pre-eclampsia & EclampsiaPre-eclampsia = new hypertension with proteinuria or organ dysfunction after 20 weeks; eclampsia adds seizures. Magnesium sulfate prevents/treats the seizures and delivery is the definitive cure.Gestational Diabetes (GDM)Glucose intolerance first recognised in pregnancy. Good control reduces macrosomia, birth trauma and neonatal problems; most cases resolve after delivery.

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Misoprostol (± mifepristone)

Anti-D immunoglobulin (± antibiotics)

📈 Exclude ectopic; three valid options

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Misoprostol (± mifepristone)

Anti-D immunoglobulin (± antibiotics)

📈 Exclude ectopic; three valid options

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Exclude ectopic; three valid options

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Exclude ectopic; three valid options

References