Diagnosis and management of first trimester miscarriage.

#### Summary points Miscarriage is the most common complication of pregnancy. The reported rate of pregnancy loss in women with a missed menstrual period and positive urine pregnancy test is 12-24%.1 The true rate of miscarriage is probably higher because many losses occur preclinically, before a menstrual period is missed.2 About 125 000 miscarriages occur annually in the United Kingdom, resulting in 42 000 hospital admissions.3 Although miscarriages mostly resolve spontaneously without treatment and rarely cause severe maternal morbidity, the burden of disease is considerable, owing to the high incidence and associated costs of diagnostic investigations, hospital admission, surgical treatment, and follow-up. The loss of a pregnancy is often distressing for women and their partners, with adverse effects on their social and psychological wellbeing. Reported UK maternal mortality rates after miscarriage in the period 1985 to 2008 range from 0.05 to 0.22 per 100 000 maternities.4 The most common causes of death were haemorrhage and sepsis, which tended to occur more often after second trimester losses. Women with miscarriages are often treated conservatively in an outpatient setting, and general practitioners are often asked to advise women on the management options available to them and to provide support during follow-up. The aim of this review is to describe the diagnosis and …