The prevalence of threatened miscarriage in Malta

Abstract

A retrospective cohort study was conducted in Malta to assess the prevalence of threatened miscarriage. The study focuses on cases managed at a local state hospital over a 12-month period. Currently, data on pregnancies prior to 22 weeks' gestation are not publicly available, which hampers understanding of the frequency and impact of threatened miscarriage. This research provides the basis for a potential prospective study which analysis the epidemiology and outcomes of threatened miscarriage and advocates for early intervention and appropriate patient counselling. The study included females who visited the Accident and Emergency Department in a local state hospital in 2019 with first trimester vaginal bleeding. It excluded patients with incomplete medical records. Data from various hospital departments were collected, anonymised and analysed to track outcomes such as miscarriage, ongoing pregnancy, ectopic or molar pregnancy. The research aimed to create a comprehensive local registry of pregnancy outcomes following threatened miscarriage, reflecting the national situation. In 2019, 711 pregnant women in Malta experienced first-trimester vaginal bleeding. Of these, 241 had successful births beyond 22 weeks' gestation, while 412 experienced miscarriages, with other outcomes including ectopic and molar pregnancies and 58 women had an unknown pregnancy outcome. A significant association was found between maternal age and risk of miscarriage, particularly higher for women aged 35-46 and those under 19. Birthweight data revealed that threatened miscarriage complications likely led to low birthweights in a significant proportion of newborns. This study analysed pregnancy outcomes which were preceded by first trimester vaginal bleeding in pregnant women in Malta. Establishing a local register of pregnancy outcomes following first trimester vaginal bleeding provides clinicians with enhanced insights into the current local context. This resource may improve patient counselling and informed policy decisions and lay the groundwork for future research in the field.

Keywords: Birthweight; Epidemiology; Maternal age; Pregnancy outcome; Prevalence; Threatened miscarriage.

Fig. 1

Summary of results.

Fig. 2

Box-plot of maternal age. Central mark is the median, cross is the mean, the edges of the box represent the 25th and 75th percentiles and the whiskers extend to the most extreme data points (excluding outliers which are shown separately).

Fig. 3

Histogram of maternal age for miscarriage and continued pregnancy cases.

Fig. 4

Histogram of maternal age for miscarriage and continued pregnancy cases, grouped into three main risk groups.

Fig. 5

WHO published growth chart with birthweights from collected TM cases superimposed. a) Female, b) Male.