Dangers of Miscarriage: Medical Risks and Complications
Miscarriage poses several serious health risks including hemorrhage, infection, and in rare cases, death, particularly in settings without adequate healthcare provision. 1
Physical Complications
Hemorrhage (excessive bleeding) is one of the most immediate and dangerous complications of miscarriage, requiring emergency care if a woman is soaking through more than one sanitary pad per hour 2
Infection can develop following incomplete miscarriage when tissue remains in the uterus, potentially leading to sepsis if untreated 3
Venous thromboembolism (VTE) risk is increased following pregnancy loss, with thromboembolism being a significant cause of maternal mortality internationally 3
Three maternal deaths attributed to VTE after pregnancy loss were reported in the UK between 2014-2016, highlighting the serious nature of this complication 3
Incomplete miscarriage presents higher risks as retained tissue can lead to prolonged bleeding and infection 4
Long-Term Health Implications
Women with history of miscarriage may have increased long-term health risks including cardiovascular disease, though evidence is mixed 3
Stillbirth (which is different from miscarriage but related) is associated with a 49% increased risk of future cardiovascular events and approximately 2-fold increased risk of cardiovascular-related mortality 3
The relationship between miscarriage and future cardiovascular disease risk remains unclear due to heterogeneity in study definitions and designs 3
Women with diminished ovarian reserve have approximately 35% increased relative risk of miscarriage, which may represent an underlying health factor 5
Psychological Impact
Psychological consequences include increased risk of anxiety, depression, post-traumatic stress disorder, and in severe cases, suicide 6
Women experiencing miscarriage in emergency departments often feel their losses are dismissed rather than acknowledged, creating experiences of marginalization 7
The psychological impact is commonly underappreciated by healthcare providers, leading to inadequate emotional support 8
Risk Factors That Increase Danger
Advanced maternal age (>35 years) increases both the risk of miscarriage and potential complications 2
Being significantly underweight or overweight increases miscarriage risk and can complicate management 2
Smoking and high alcohol consumption are modifiable risk factors that increase miscarriage risk 2
Previous miscarriages increase the risk of complications in subsequent pregnancies 6
Management Considerations to Reduce Risks
Early and accurate diagnosis via transvaginal ultrasound is essential to prevent complications and inappropriate interventions 2
Management options include expectant management (waiting for natural completion), medical management with medications like misoprostol, or surgical evacuation 4
Surgical management is preferably performed under ultrasound guidance to reduce the risk of uterine perforation 4
Women who are Rh-negative require anti-D prophylaxis if they experience bleeding at or before 12 weeks' gestation to prevent Rh sensitization 2
Serial hCG monitoring until levels return to the non-pregnant state helps ensure complete resolution 4
Special Considerations
Miscarriage is not just a medical event but represents the loss of potential life, causing significant emotional trauma different from other medical emergencies 7
The economic cost of miscarriage is substantial, estimated at £471 million per year in the UK alone 6
Recurrent miscarriage (three or more consecutive losses) affects approximately 0.7% of women and requires specialized care 6
Miscarriage serves as a sentinel marker for various obstetric risks in future pregnancies, indicating a need for specialized preconception and obstetric care 6