| Factor | Relative Risk |
|---|
| Maternal age ≥35 | 2–4× (aneuploidy) |
| Prior miscarriage | 1: 20%; 2: 28%; 3+: 43% |
| Chromosomal abnormality | 50–60% of 1st trimester losses |
| Uterine anomalies | Septate, bicornuate, fibroids |
| Endocrine | Uncontrolled diabetes, thyroid disease, PCOS, luteal phase defect |
| Thrombophilia | APS, Factor V Leiden |
| Lifestyle | Smoking, alcohol, cocaine, high caffeine (>200mg), obesity |
| Infections | Listeria, Toxoplasma, parvovirus, syphilis, malaria |
| Environmental | Radiation, toxins, hyperthermia |
Clinical Presentation
- Vaginal bleeding (spotting to heavy), cramping, passage of tissue.
- Some are asymptomatic (missed abortion) – diagnosed on ultrasound.
Management Options
- Expectant: Wait for spontaneous passage (80% complete in 2–4 weeks).
- Medical: Misoprostol ± mifepristone (expedites).
- Surgical: D&C (suction curettage) – fastest, most predictable.
Psychological Support
- Grief is normal; no "right" way to feel.
- Recurrent pregnancy loss (RPL) evaluation after 2–3 losses.
- Most women have successful subsequent pregnancy.
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