Subsequent pregnancy outcomes after second trimester miscarriage or termination for medical/fetal reason: a systematic review and meta-analysis of observational studies

Keya Patel, Danielle Pirie, Alexander Heazell, Bethan Morgan, Andrea Woolner

Research output: Contribution to journalArticlepeer-review


Introduction: Women with a prior stillbirth or a history of recurrent first trimester miscarriages are at increased risk of adverse pregnancy outcomes. However, little is known about the impact of a second trimester pregnancy loss on subsequent pregnancy outcome. This review investigated if second trimester miscarriage or termination for medical reason or fetal anomaly (TFMR/TOPFA) is associated with future adverse pregnancy outcomes.
Materials and methods: A systematic review of observational studies was conducted. Eligible studies included women with a history of a second trimester miscarriage or termination for medical reasons and their pregnancy outcomes in the subsequent pregnancy. Where comparative studies were identified, studies which compared subsequent pregnancy outcomes for women with and without a history of second trimester loss or TFMR/TOPFA were included. The primary outcome was livebirth, and secondary outcomes included: miscarriage (first and second trimester), termination of pregnancy, fetal growth restriction, caesarean section, preterm birth, pre-eclampsia, antepartum haemorrhage, stillbirth and neonatal death. Studies were excluded if exposure was non-medical termination or if related to twins or higher multiple pregnancies. Electronic searches were conducted using the online databases (MEDLINE, Embase, PubMed and The Cochrane Library) and searches were last updated on the 16th of June 2023. Risk of bias was assessed using the Newcastle-Ottawa scale. Where possible, meta-analysis was undertaken. PROSPERO registration: CRD42023375033.
Results: Ten studies were included, reporting on 12 004 subsequent pregnancies after a second trimester pregnancy miscarriage. No studies were found on outcomes after second trimester TFMR/TOPFA. Overall, available data were of ‘very low quality’ using GRADE assessment. Meta-analysis of cohort studies generated estimated outcome frequencies for women with a previous second trimester loss as follows: live birth 81% [95% CI 64-94], miscarriage 15% [95% CI 4-30, preterm birth 13% [95% CI 6-23]).The pooled odds ratio for preterm birth in subsequent pregnancy after second trimester loss in case-control studies was OR 4.52 (95% CI 3.03-6.74).
Conclusions: Very low certainty evidence suggests there may be an increased risk of preterm birth in a subsequent pregnancy after a late miscarriage. However evidence is limited. Larger, higher quality cohort studies are needed to investigate this potential association.
Original languageEnglish
Pages (from-to)413-422
JournalActa Obstetricia et Gynecologica Scandinavica
Issue number3
Early online date30 Nov 2023
Publication statusPublished - 14 Feb 2024


  • second trimester miscarriage/spontaneous abortion
  • late miscarriage/spontaneous abortion
  • termination of pregnancy for medical reason or fetal anomaly (TFMR/TOPFA)
  • subsequent pregnancy outcomes
  • termination of pregnancy for fetal anomaly (TOPFA)


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