Management Strategies for Miscarriage: A Literature Review of Current Clinical Practices and Emerging Treatments

Author(s): Zlatko Kirovakov, Antonio Dushepeev, Stefani Markova

Early miscarriage, defined as the loss of pregnancy before the 12th week, affects 10-20% of clinically recognized pregnancies. Curettage has traditionally been the standard procedure, but expectant management and medical therapies have gained prominence in recent years. This review examines current treatment strategies for miscarriage. Recurrent miscarriage (RM), defined as three or more consecutive pregnancy losses, and affects 1-2% of women. While early miscarriage is common experience, recurrent miscarriage poses unique challenges that require distinct management strategies. RM is often linked to elevated anti-phospholipid antibodies (5-15%), sperm DNA damage (up to 85%), and hyper-receptive endometrial stromal cells, which can accept low-quality embryos. Women with thyroid-related antibodies or elevated TSH levels are at a higher risk of miscarriage, with researchindicating a doubled risk in the first trimester. This review analyzes literature and guidelines published between 2018 and 2024, highlighting three primary treatment options: expectant care, medical therapy, and surgical intervention. The PRISMA method was employed for systematic review and data extraction from studies published in this period. Expectant management offers a non-invasive option with a success rate of 80-90%, while misoprostol is a medical approach with success rates between 75-90%. IVF with genetic testing is recommended for RM associated with chromosomal abnormalities, with success rates of 50-70%. Hysteroscopic metroplasty has a 60-85% success rate for women with uterine malformations, such as a septate uterus. Progesterone therapy can improve live birth rates by 20-30% in women with a history of multiple miscarriages. A combination of low-molecular-weight heparin and aspirin is more effective than aspirin alone, improving outcomes by 30-40% in women with antiphospholipid syndrome. While curettage remains the standard procedure for severe cases, expectant and medical therapies are effective alternatives, particularly when addressing underlying causes of RM. Advances in personalized care show promise for improving outcomes in affected women.