The predictive value of first-trimester ultrasound and biochemical markers in threatened miscarriage

Abstract

This retrospective population-based study determined the prevalence and outcomes of first-trimester vaginal bleeding in Malta. All 1,456 women attending A&E at Mater Dei Hospital in 2019 with pregnancies ≤12⁺⁶ weeks were included. Bleeding occurred in 711 cases (48.8%). Pregnancy loss before 22 weeks was 55.7% in the threatened-miscarriage cohort versus 9.6% in non-bleeding controls. Among women delivering beyond 22 weeks, threatened miscarriage was associated with lower birthweight (p<0.001) and shorter gestation (p=0.004). Maternal age ≥35 years markedly increased loss risk (68%, p<0.001). The findings provide the first Malta-specific baseline data and support development of a predictive model integrating ultrasound and biochemical markers to improve risk stratification and counselling.