Spontaneous Miscarriage Management Experience: A Systematic Review

Angela L Ho; Algeny Hernandez; John M Robb; Stephanie Zeszutek; Sandy Luong; Emiru Okada; Karan Kumar

doi:10.7759/cureus.24269

Spontaneous Miscarriage Management Experience: A Systematic Review

Cureus. 2022 Apr 19;14(4):e24269. doi: 10.7759/cureus.24269. eCollection 2022 Apr.

Authors

Angela L Ho¹, Algeny Hernandez¹, John M Robb², Stephanie Zeszutek¹, Sandy Luong³, Emiru Okada², Karan Kumar⁴

Affiliations

¹ Obstetrics and Gynecology, Touro College of Osteopathic Medicine, Middletown, USA.
² Obstetrics and Gynecology, University of California Irvine, Irvine, USA.
³ Obstetrics and Gynecology, Drake University, Des Moines, USA.
⁴ Surgery, Touro College of Osteopathic Medicine, Middletown, USA.

Abstract

Background: The estimated frequency of spontaneous miscarriage is about a quarter of all clinically identified pregnancies in the United States. Women typically go to the emergency department (ED) or outpatient clinic when they experience symptoms, including but not limited to vaginal bleeding, abdominal pain, and contractions. The care that is provided varies from place to place.

Methods: Researchers searched articles from 2010 to 2021 for reports mentioning treatment for spontaneous abortion. Search terms included "miscarriage aftercare" and "spontaneous abortion care," seeking articles addressing the psychological effects of miscarriage and reporting patient experiences in different clinical settings. Data were independently reviewed, graded for evidence quality, and assessed for risk bias using the AMSTAR checklist.

Results: The search strategy yielded 2,275 articles, six of which met the inclusion criteria. Conservative, medical, and surgical management were provided, with surgical management being more common among women with higher education and socioeconomic status. All qualitative studies reported dissatisfaction with care provided in the emergency department, partially due to a lack of emotional support. Structured bereavement intervention was beneficial for women experiencing early pregnancy loss and led to fewer reports of despair. The quantitative studies referenced interventions that aided patients in coping with pregnancy loss and identified several factors influencing the type of treatment received as well as the patient's ability to cope with feeling depressed following a miscarriage.

Conclusion: Psychological management is not regularly addressed in the emergency department, and protocols including bereavement education for healthcare providers as well as patient involvement in management would improve the overall patient experience with spontaneous miscarriage care.

Keywords: miscarriage; postnatal depression; postpartum mental health; spontaneous abortion; women's mental health.

Publication types

Review