{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T02:40:17Z","timestamp":1756435217213,"version":"3.44.0"},"reference-count":39,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T00:00:00Z","timestamp":1749427200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008376","name":"Helsingin ja Uudenmaan Sairaanhoitopiiri","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008376","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003125","name":"Suomen Kulttuurirahasto","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003125","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The treatment of miscarriage has transformed substantially from surgical to non\u2010surgical. The aim of this study was to evaluate the rates of adverse events related to the treatment of miscarriage and their risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>This nationwide retrospective cohort study included 69\u2009593 fertile\u2010aged (15\u201349\u2009years) women who experienced their first miscarriage during 1998\u20132016 and received a diagnostic code of missed abortion or blighted ovum in a public hospital. We used data from the Finnish National Hospital Discharge Registry (NHDR). Miscarriage type, treatment modalities, and treatment\u2010related adverse events (secondary surgery for any reason, infection and severe adverse events) were identified using diagnostic and surgical procedure codes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Since 2004, non\u2010surgical management has been the dominant treatment of miscarriage in Finland. Between 1998 and 2016, a total of 11\u2009397 women (16.4%) experienced at least one miscarriage treatment\u2010related adverse event. The need for secondary surgery was the most common adverse event and more common after primary non\u2010surgical treatment (22.0% vs. 3.8%). However, the annual rate of secondary surgery after non\u2010surgical treatment declined from 34.8% in 1998 to 15.9% in 2016. The total number of women undergoing surgical treatment (primary or secondary) declined from 3918 (84.6%) to 651 (23.1%). Age was associated with an increased risk of secondary surgery (age\u2009\u2265\u200925; Adjusted odds ratio [AdjOR] 1.15, 95% CI 1.07\u20131.24) and with a decreased overall risk of infection (age 40\u201349\u2009years; AdjOR 0.51 [0.40\u20130.63]). Parity was associated with lower risk of secondary surgery (one delivery, AdjOR 0.82 [0.78\u20130.95], and \u22652 deliveries, AdjOR 0.75, [0.71\u20130.84]) and infection (one delivery, AdjOR 0.85, [0.77\u20130.95]; \u22652 deliveries, AdjOR 0.74 [0.66\u20130.84]). Severe adverse events were rare (0.2%\u20130.4%) and did not differ between the two treatment options for either type of miscarriage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Despite significant changes in miscarriage treatment practices, no substantial or alarming increase in treatment\u2010associated adverse events was detected. Both treatment options proved safe for the two types of miscarriage studied. These findings are important regarding the provision of individualized counseling and for the allocation of healthcare resources.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.15174","type":"journal-article","created":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T05:03:43Z","timestamp":1749445423000},"page":"1720-1730","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Miscarriage treatment\u2010related adverse events: A nationwide registry study from Finland"],"prefix":"10.1111","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4162-9764","authenticated-orcid":false,"given":"Nea","family":"Helle","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Helsinki and Helsinki University Hospital  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maarit","family":"Mentula","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Helsinki and Helsinki University Hospital  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomi","family":"Sepp\u00e4l\u00e4","sequence":"additional","affiliation":[{"name":"Department of Information and Service Management Aalto University School of Business  Espoo Finland"},{"name":"Business School University of Eastern Finland  Kuopio Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mika","family":"Gissler","sequence":"additional","affiliation":[{"name":"Department of Data and Analytics Finnish Institute for Health and Welfare (THL)  Helsinki Finland"},{"name":"Department of Molecular Medicine and Surgery, and Neurobiology Karolinska Institute  Stockholm Sweden"},{"name":"Academic Primary Health Care Center, Region Stockholm  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0927-0472","authenticated-orcid":false,"given":"Maarit","family":"Niinim\u00e4ki","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center University of Oulu and Oulu University Hospital  Oulu Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8671-130X","authenticated-orcid":false,"given":"Oskari","family":"Heikinheimo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Helsinki and Helsinki University Hospital  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,6,9]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198807283190401"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002899"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00682-6"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0015-0282(02)04694-0"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa044064"},{"key":"e_1_2_14_7_1","first-page":"1","article-title":"Management of first\u2010trimester miscarriage: a systematic review and network meta\u2010analysis","volume":"12","author":"Al Wattar BH","year":"2019","journal-title":"Hum Reprod Update"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1715726"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12034"},{"key":"e_1_2_14_10_1","unstructured":"THL (National Institute for Health and Welfare).Statistical Report 4\/2019\u2010Induced abortions in the Nordic countries 2017.2019."},{"key":"e_1_2_14_11_1","first-page":"2120","article-title":"Trends in the incidence, rate and treatment of miscarriage\u2010nationwide register\u2010study in Finland","volume":"34","author":"Linnakaari R","year":"2019","journal-title":"Hum Reprod"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.18940"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2005.12.072"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmt045"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38828.593125.55"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.0933"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1302417"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f3676"},{"key":"e_1_2_14_19_1","unstructured":"National Institute for Health and Care Excellence.NICE guideline 2019. 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