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Murray Enkin

, Marc J. N. C. Keirse

, James Neilson

, Caroline Crowther

, Lelia Duley

, Ellen Hodnett

, and Justus Hofmeyr

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date: 26 November 2020

Miscarriage is the spontaneous loss of a pregnancy before the fetus is viable. Miscarriage is common. One in seven clinically recognized pregnancies will miscarry, usually during the first 14 weeks of pregnancy. Over half the babies who are miscarried during this period have a chromosomal abnormality. Other factors that influence the risk of miscarriage include maternal age over 35 years, multiple pregnancy, polycystic ovaries, autoimmune disorders, poorly controlled diabetes, and having had two or more previous miscarriages. Chapter 14 discusses confirmation of fetal life, prevention of miscarriage (including bed-rest and hospitalization, hormones, diethylstilbestrol, progestogens, human chorionic gonadotrophin, and luteinizing hormone releasing hormone agonists), immunotherapy, interventions for women with autoimmune conditions, other medications, care following spontaneous miscarriage or missed abortion, the ‘wait and see’ versus surgical evacuation, medical versus surgical evacuation, and surgical evacuation (including analgesia versus general anaesthetic, suction versus conventional curettage, and prophylactic antibiotics).

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