Beyond the bleeding : predicting pregnancy outcomes after threatened miscarriage

Abstract

This three-phase research project examined pregnancy outcomes following first-trimester threatened miscarriage (TM). Phase 1 (retrospective epidemiological analysis) established local prevalence and outcome patterns in Malta for 2019. Phase 2 (scoping review) mapped existing ultrasound and biochemical markers for predicting miscarriage. Phase 3 (prospective case-control study) developed and validated predictive models using multivariate logistic regression (AUC 0.89 on test data) and Random Forest (AUC 0.97 on test data). Key predictive markers identified were progesterone, mean gestational sac diameter (MGSD), β-hCG, crown-rump length (CRL), cervical length, maternal age (35–46 years), fetal heart rate (FHR), and sFlt-1:PlGF ratio. The study provides the first Malta-specific data and a clinically usable algorithm to improve risk stratification and counselling for women experiencing early-pregnancy bleeding.