Miscarriage hospitalisations: a national population-based study of incidence and outcomes, 2005-2016

BackgroundEarlymiscarriage is one of the most common obstetric causes of maternal morbidity early in pregnancy. However, data concerning non-fatal complications among hospitalisations forearly miscarriage are lacking. The aim of this study was to determine whether there were changes in the incidence, management and outcomes of early miscarriage hospitalisations between 2005 and 2016.MethodsThis is a nationwide population-based study of 50,538 hospitalisations with a diagnosis of earlymiscarriage of all acute maternity hospitals in Ireland. Electronic health records were retrieved using the Hospital In-Patient Enquiry database. Main outcomes include the incidence rates of hospitalisations and management for earlymiscarriage, and rates of blood transfusion and length of stay over 2days.ResultsOverall, 50,538 hospitalisations forearly miscarriage were identified from 2005 to 2016. The risk of hospitalisation decreased from 70.6 per 1000 deliveries (95% CI 68.4 to 72.8) in 2005 to 49.7 per 1000 deliveries (95% CI 49.7 to 53.3) in 2016; however, the risk of blood transfusion increased over time (ratio: 2.0; 95% CI 1.6 to 2.4). Women of advanced maternal age had a higher risk of hospitalisations. There were less blood transfusions among women who undertook medical treatment (ratio: 0.3; 95% CI 0.1 to 0.5), but they had an increased risk of staying over 2days at the hospital (ratio: 1.5; 95% CI 1.2 to 1.9) compared to evacuation of retained products of conception.ConclusionsHospitalisation rates for earlymiscarriage decreased over time with an increase in risk of blood transfusion and an extended length of stay at the hospital. Women who underwent medical management did not have as many blood transfusions as those undergoing surgical management. However, they had an increased risk of an extended stay. Research is needed to explore both outpatient and inpatient settings in order to improve the management and care provided.