Women who suffer miscarriages should have access to minimum health standards wherever they are in the world, a team of scientists recommend.
They say existing care is inconsistent and poorly organised worldwide, and a new system is needed to end variations in the definition, causes, treatment and effects of a miscarriage.
Women can suffer debilitating mental and physical conditions after a miscarriage, and women who endure multiple miscarriages should get extra care as standard, the scientists suggested.
About 23 million pregnancies, or 15 per cent, end with miscarriages, according to three papers published in The Lancet on Monday.
"Many women have concerns over the unsympathetic care they receive following a miscarriage - with some not being offered any explanation, and the only advice they receive being to try again. This is not good enough," said Professor Siobhan Quenby, co-lead author of the report.
"Silence around miscarriage remains, not only for women who experience miscarriage but also among health-care providers, policymakers, and research funders. We urge all countries to develop and provide more comprehensive miscarriage care services," she said.
One in 10 women experience a miscarriage in their lifetime and 1 per cent have more than one.
The report highlights that the current approach to miscarriage care must be improved, by providing more accurate diagnoses, appropriate investigations and improved treatments to prevent miscarriage.
After a first miscarriage, women should be offered information about miscarriage, the physical and mental health needs, and support in future pregnancies, the authors say.
Following a second miscarriage, women should be offered an appointment at a miscarriage clinic, blood count and thyroid tests, and specialist care. In subsequent pregnancies there should be extra support and early scans, they say.
After three miscarriages, additional tests and treatments should be offered under the care of a medical consultant, and genetic testing of pregnancy tissue should be offered, as well as pelvic ultrasound and, if necessary, parental genetic testing.
"Recurrent miscarriage is a devastating experience for most women, but the mental health impact is rarely acknowledged or addressed in medical care," says Professor Arri Coomarasamy, co-lead author of the report from the University of Birmingham.
"Women can experience trauma and bereavement, which may have no obvious signs and can go unrecognised."
For women, miscarriages is associated with anxiety, depression, and post-traumatic stress disorder, the report found.
Risk factors for an increased risk of miscarriage include chromosomal anomalies in the foetus, maternal age, previous miscarriages, paternal age of 40 years or more, very low or high body mass index, Black ethnicity, smoking, alcohol, persistent stress, working night shifts, exposure to air pollution, and exposure to pesticides.
"Our recommended model of care ensures that all miscarriages receive care, and that extra support is given to women experiencing recurrent miscarriages," added Prof Quenby, deputy director at the UK-based Tommy's National Centre for Miscarriage Research.
The authors added that actual number of miscarriages will be higher than the 23 million estimate because many miscarriages are managed at home and go unreported or unrecognised.
"Miscarriage prevention remains a low public health priority in many low- and middle-income countries, where there are many competing health care priorities and services for women can be especially limited," said Prof Chandrika N Wijeyaratne, from Sri Lanka's University of Colombo.
"There needs to be a minimum service available globally for women with recurrent miscarriage."
