Incidence and outcome of bleeding before the 20th week of pregnancy: prospective study from general practice

Abstract Objective: To estimate the miscarriage rate in a cohort of pregnant women and the final outcome of pregnancy. Design: Two year prospective community study. Setting: Women registered with four semirural practices at one health centre. Subjects: 626 pregnant women from a population 21 448, 5140 of whom were women aged 15-44 years. Main outcome measures: Vaginal bleeding and outcome of pregnancy. Results: 76 of the 89 women with an unwanted pregnancy requested a termination. In the 550 ongoing pregnancies bleeding occurred before the 20th week in 117 (21%), and 67 (12%) ended in miscarriage. The risk of miscarriage was not significantly increased after a miscarriage in the previous pregnancy (11 (15%) women had miscarriage v 55 (12%) women who had not had miscarriage) who had previously had a live birth). Of the 117 women with bleeding, 64 were not admitted to hospital by the general practitioner; 42 of these women had an ultrasound examination at the health centre and 19 subsequently miscarried at home. In hospital 41 of 46 women who miscarried had evacuation of the uterus. Conclusions: Bleeding occurred in one fifth of recognised pregnancies before the 20th week and over half of these miscarried. Treatment of women with miscarriage at home means current statistics on miscarriage in Britain are missing many cases. Key messages No national statistics for Britain are published on miscarriages Extrapolations from this survey indicate that in 1993 there may have been 70 000-90 000 miscarriages in England and Wales Bleeding in early pregnancy is followed by a live birth in about half the affected pregnancies At least a quarter of all miscarriages were treated at home by general practitioners and would therefore not be recorded in any published statistics Women who had had a miscarriage did not have a significantly higher chance of a second consecutive miscarriage