Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
Lancet. 2021 May 1;397(10285):1668-1674. doi: 10.1016/S0140-6736(21)00683-8. Epub 2021 Apr 27.
The physical and psychological effect of miscarriage is commonly underappreciated. The journey from diagnosis of miscarriage, through clinical management, to supportive aftercare can be challenging for women, their partners, and caregivers. Diagnostic challenges can lead to delayed or ineffective care and increased anxiety. Inaccurate diagnosis of a miscarriage can result in the unintended termination of a wanted pregnancy. Uncertainty about the therapeutic effects of interventions can lead to suboptimal care, with variations across facilities and countries. For this Series paper, we have developed recommendations for practice from a literature review, appraisal of guidelines, and expert group discussions. The recommendations are grouped into three categories: (1) diagnosis of miscarriage, (2) prevention of miscarriage in women with early pregnancy bleeding, and (3) management of miscarriage. We recommend that every country reports annual aggregate miscarriage data, similarly to the reporting of stillbirth. Early pregnancy services need to focus on providing an effective ultrasound service, as it is central to the diagnosis of miscarriage, and be able to provide expectant management of miscarriage, medical management with mifepristone and misoprostol, and surgical management with manual vacuum aspiration. Women with the dual risk factors of early pregnancy bleeding and a history of previous miscarriage can be recommended vaginal micronised progesterone to improve the prospects of livebirth. We urge health-care funders and providers to invest in early pregnancy care, with specific focus on training for clinical nurse specialists and doctors to provide comprehensive miscarriage care within the setting of dedicated early pregnancy units.
流产对身体和心理的影响通常被低估。从流产的诊断，到临床管理，再到支持性的后续护理，对女性、她们的伴侣和护理人员来说，这都是一段充满挑战的旅程。诊断方面的挑战可能导致护理延迟或无效，并增加焦虑。对流产的误诊可能导致意外终止想要的妊娠。对干预措施治疗效果的不确定性会导致护理效果不佳，不同医疗机构和国家之间存在差异。在本系列论文中，我们根据文献回顾、指南评估和专家组讨论，制定了实践建议。这些建议分为三类：（1）流产的诊断，（2）有早期妊娠出血史的女性预防流产，（3）流产的管理。我们建议每个国家都像报告死产一样，报告年度流产的汇总数据。早期妊娠服务需要专注于提供有效的超声服务，因为这是流产诊断的核心，并且能够提供期待疗法、米非司酮和米索前列醇的药物治疗以及手动真空抽吸的手术治疗。对于同时具有早期妊娠出血和既往流产史双重风险因素的女性，可以建议使用阴道用微粒化黄体酮，以提高活产的可能性。我们敦促医疗保健资金提供者和提供者投资于早期妊娠护理，特别注重培训临床护士专家和医生，以便在专门的早期妊娠单位内提供全面的流产护理。
