Spontaneous abortions and missed miscarriage in a public hospital: maternal and sociodemographic profileABSTRACT
Objective: Analyze the influence of socio-demographic and maternal factors on the occurrence of spontaneous and missed miscarriage.
Method: A descriptive epidemiological study that analyzed socio-demographic, obstetric, and nursing variables for the period 2019-2024, collected in electronic records of a hospital in the northwest of Paraná, and analyzed using the Pearson chi-square test.
Results: Of the 436 cases, predominance was identified until the 12th week of pregnancy (82.2% of missed miscarriage and 67.7% of spontaneous abortions). Abortions were significantly more prevalent in women with up to eight years of study and those with higher educational levels. Adolescents and women aged 35 or older were more vulnerable to missed miscarriage, while those aged 16 to 34 were more vulnerable to spontaneous abortion.
Conclusion: Maternal age and schooling influence the types of abortion, evidencing sociodemographic inequalities that permeate the reproductive process. Public policies that broaden access and qualify reproductive care in the Single Health System are necessary.
DESCRIPTORS:
Women; Maternal Age, Abortion; Spontaneous; Abortion; Missed; Socioeconomic Factors.
HIGHLIGHTS
1. Higher education was associated with missed miscarriage.
2. Abortion was prevalent in low schooling.
3. Adolescents and ≥ 35 years old: most vulnerable to missed mi scarriage.
4. Prevalence of abortions until the 12th week of gestation.
RESUMO
Objetivo: Analisar a influência de fatores sociodemográficos e maternos na ocorrência de abortos espontâneos e retidos.
Método: Estudo epidemiológico descritivo que analisou variáveis sociodemográficas, obstétricas e assistenciais referentes ao período de 2019-2024, coletadas em prontuários eletrônicos de um hospital no noroeste do Paraná, e analisadas utilizando o teste qui-quadrado de Pearson.
Resultados: Dos 436 prontuários, identificou-se predominância até a 12ª semana gestacional (82,2% dos abortos retidos e 67,7% dos espontâneos). Abortos espontâneos foram significativamente mais prevalentes em mulheres com até oito anos de estudo, e os retidos entre aquelas com maior nível educacional. Adolescentes e mulheres com 35 anos ou mais apresentaram maior vulnerabilidade à ocorrência de aborto retido, enquanto as com idade entre 16 e 34 anos ao espontâneo.
Conclusão: Idade materna e escolaridade influenciam os tipos de aborto, evidenciando desigualdades sociodemográficas que permeiam o processo reprodutivo. Necessário políticas públicas que ampliem o acesso e qualifiquem o cuidado reprodutivo no Sistema Único de Saúde.
DESCRITORES:
Mulheres; Idade Materna; Aborto Espontâneo; Aborto Retido; Fatores Socioeconômicos.
HIGHLIGHTS
1. Maior escolaridade esteve associada ao aborto retido.
2. Aborto espontâneo mostrou-se prevalente em baixa escolaridade.
3. Adolescentes e ≥ 35 anos: mais vulneráveis ao aborto retido.
4. Predomínio de abortos até a 12ª semana de gestação.
RESUMEN
Objetivo: Analizar la influencia de factores sociodemográficos y maternos en la ocurrencia de abortos espontáneos y retenidos.
Método: Estudio epidemiológico descriptivo que analizó variables sociodemográficas, obstétricas y asistenciales referentes al período de 2019-2024, recolectadas en historias clínicas electrónicas de un hospital en el noroeste de Paraná, y analizadas utilizando la prueba chi-cuadrado de Pearson.
Resultados: De las 436 historias clínicas, se identificó predominancia hasta la 12ª semana gestacional (82,2% de los abortos retenidos y 67,7% de los espontáneos). Los abortos espontáneos fueron significativamente más prevalentes en mujeres con hasta ocho años de estudio, y los retenidos entre aquellas con mayor nivel educativo. Adolescentes y mujeres de 35 años o más presentaron mayor vulnerabilidad a la ocurrencia de aborto retenido, mientras que las de edad entre 16 y 34 años al espontáneo.
Conclusión: La edad materna y la escolaridad influyen en los tipos de aborto, evidenciando desigualdades sociodemográficas que permeabilizan el proceso reproductivo. Es necesario políticas públicas que amplíen el acceso y califiquen el cuidado reproductivo en el Sistema Único de Salud.
DESCRIPTORES:
Mujeres; Edad Materna; Aborto Espontáneo; Aborto Retenido; Factores Socioeconómicos.
HIGHLIGHTS
1. Mayor escolaridad estuvo asociada al aborto retenido.
2. El aborto espontáneo se mostró prevalente en baja escolaridad.
3. Adolescentes y ≥ 35 años: más vulnerables al aborto retenido.
4. Predominio de abortos hasta la 12ª semana de gestación.
INTRODUCTION
Spontaneous miscarriage and missed miscarriage are gestational complications with distinct characteristics, differentiation of which is essential for proper clinical management 1-2. Abortion occurs without intentional intervention to interrupt pregnancy and is usually preceded by signs such as bleeding and cramps 3-4. The missed miscarriage, in turn, is characterized by fetal death without the expulsion of gestational material, being often diagnosed by ultrasound and, in general, without obvious clinical signs4.
Both types represent potentially life-threatening conditions in the pregnancy-puerperal cycle, in addition to having a significant impact on the physical and emotional health of the woman5. Its etiology is multifactorial, covering genetic causes, maternal age, infections, uterine abnormalities, and/or hormonal disorders, as well as sociodemographic factors, such as age6, schooling,2,7 and color/race8, which interact with broader social determinants7. These elements reinforce the importance of timely recognition of risk factors to support early diagnosis and adoption of appropriate clinical interventions.
Abortion is the fourth leading cause of maternal death in Brazil, unlike in developed countries, where abortion death rates are low.4 It is estimated that 10 to 15% of pregnancies in Brazil result in spontaneous miscarriage4, but there are no data on the missed miscarriage. However, in other contexts, such as Iraq, they account for between 10 and 20% of pregnancies1.
The frequency of these events, associated with serious maternal complications and inequalities in access to health services, and also psychosocial impacts such as mental suffering9 and mourning processes10, increases the complexity of care. These aspects highlight the relevance of abortions as a public health problem, and the need for preventive and qualifying care strategies such as multidisciplinary action and strengthening obstetric care11.
In this scenario, the differentiation between the two main types of abortions and the identification of specific characteristics related to each of them are fundamental to improve surveillance, guide clinical management, and qualify health policies and practices. In view of this, the present study aimed to analyze the influence of socio-demographic and maternal factors in the occurrence of spontaneous and retreated abortions.
METHOD
A descriptive epidemiological study was conducted in a school hospital located in the northwestern region of the state of Paraná, Brazil. The institution carries out care exclusively by the Unified Health System (SUS), has 123 beds and records, on average, 12 thousand hospitalizations per year, and, in the obstetric area, in 2024, it carried out 1200 births. The recommendations of Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) were used in the preparation of this study report.
Although the literature describes several clinical classifications of abortion, such as inevitable, incomplete, complete, infected, usual, or recurrent4, the present study included only cases registered as spontaneous miscarriage or missed miscarriage. This delimitation stems from both the epidemiological relevance and the greater consistency and comparability of the data available in the analyzed scenario, which enable a more robust quantitative approach.
The data was collected between March and November 2024, using electronic records of women who were attended between 2019 and 2024. The inclusion criteria were: diagnosis of abortion identified by codes O03 and O021 - spontaneous abortion and missed miscarriage, respectively, of the International Classification of Diseases- CID 10. Cases of isolated vaginal bleeding were not included, and the records for which the absence of records did not allow the identification of characteristics of the women or the abortion were excluded. Of the total 234 registers of spontaneous abortions and 240 missed miscarriage cases, 88 and 97 cases were excluded, respectively, due to incompleteness prejudicing the analysis and characterization of the information.
The variables of interest were: age group, in years (≤15; 16-34; ≥35); education (≤8 years and >8 years); civil status (with and without companion); self-declared race/color of skin (white; not white); number of births (primary; multiple); history of prior abortion (yes; no); gestational age (≤12 weeks and 6 days; ≥13 weeks); municipality of residence (up to 100 thousand inhabitants; more than 100 thousand inhabitants); year of admission (2019, 2020, 2021, 2022, 2023, 2024); referred pain (yes; no); and referral of other service (yes; no).
The data were collected by consulting the study hospital’s computerized system, which was registered in a spreadsheet developed by the researchers and made available electronically. Before starting the collection, a pilot test was conducted using records from 13 previous years that were not included in the survey, as the form needed to be reformulated.
Two properly trained researchers were responsible for collecting the information: a nursing student and a nurse, a teacher who was also responsible for the spreadsheet-filling conference. To ensure the accuracy and integrity of the data, a 10% draw process was adopted for review and verification, carried out by two researchers, who identified and corrected possible errors or inconsistencies, reinforcing the reliability of the information.
In the analysis, to evaluate the relationship between the types of abortion (dependent variable) and the sociodemographic and reproductive variables (independent variables), the Pearson chi-square test or, in cases where the expected frequency in at least 20% of the cells was less than 5, the exact Fisher test was applied. In addition, the adjusted standardized residues in the contingency tables were interpreted to determine whether the observed frequencies in the categories were significantly higher or lower than expected.
Standardized waste with absolute values greater than 1.96 was considered indicative of significant contributions to the global association, allowing us to identify which specific categories contributed positively or negatively to the results. Cases with missing values or incomplete information were excluded from the bivariate analysis. All analyses were conducted using a 5% significance level (p < 0.05). The software used was IBM SPSS Statistics 30®.
The matrix study was authorized by the Commission for the Regulation of the Academic Activities of the Study Hospital and approved by the Ethics Committee in Human Research (CEP) of the signatory institution (Opinion No. 6.656.413) on 19 February 2024.
RESULTS
Considering the 436 records analyzed, it was found that the two types of abortion in the study were more frequent in white women, multiple couples, and occurred up to 12 weeks and six days of gestation. Spontaneous abortion predominated among those with the lowest level of education and the age group of 16 to 34 years. Missed miscarriage were more frequent among women with an educational level of more than eight years of study, with a relatively high incidence among adolescents and women of more advanced age groups (Table 1).
Association between sociodemographic and clinical-epidemiological variables and type of abortion. Maringá, PR, Brazil, 2019 to 2024
It is observed that schooling and age group presented a statistically significant association with the type of abortion, being the most frequent spontaneous abortion among women with up to eight years of study and in the age group of 16 to 34 years, while retreatment abortion predominated among those with more than eight years of schooling and among adolescents or women 35 years or older. The other independent variables analyzed did not present a statistically significant association with the outcome (Table 1).
In the year 2023, the number of missed miscarriage was more than double the previous year. Spontaneous abortions also showed growth, though more discreet, from 36 (16.1%) in 2022 to 47 (21.1%) in 2023 (Figure 1).
Comparison of the number of spontaneous miscarriages and missed miscarriages over the study period. Maringá, PR, Brazil, 2019 to 2024 Source: The authors (2025).
Regarding access to health care, it was observed that the majority of women with miscarriage, 157 (70.4%), and withdrawn, 139 (65.3%), sought hospital in a study on a spontaneous request. The rest were forwarded by health units belonging to the same municipality or to municipalities in the region.
As for the municipality of residence, of the 223 cases of spontaneous abortion, 125 (56.1%) were residents of the municipality where the hospital was located and 98 (43.9%) were referred. Of the 213 missed miscarriage, 108 (50.7%) were women resident in Maringá and 105 (49.3%) were referred. Pain at the time of admission to the service was mentioned by 50 (23.5%) women in the cases of missed miscarriage and by 111 (49.8%) of those with spontaneous abortion.
DISCUSSION
This study identified that the majority of women who had a miscarriage or retirement were white, which differs from the literature in relation to other states and countries. This divergence is related to the fact that 64.6% of the population residing in the municipality of the location of the study hospital and in the state of Paraná is of the race/color declared white 12. A study conducted with national data regarding hospitalizations in the public health system in Brazil demonstrated that abortions are more frequent among pardas13, a result also found in a study that considered only the state of Bahia8. In contrast, in the United Kingdom, the majority of women who had abortions were black 14.
Such variations reinforce the importance of considering territorial, racial and socioeconomic contexts in the analysis of reproductive outcomes. The human development indicators between the states of Paraná and Bahia show significant structural differences. In the state of Paraná, where this study was conducted and from which the majority of the study participants come, the Human Development Index (IDH) is 0.769, being classified as high15. Moreover, municipalities with low or medium HDI tend to present structural inequalities that influence the sociodemographic profile of women14 and directly impact access to health services, the quality of the care offered, and the outcomes related to abortion.
In addition to these markers, the number of pregnancies also proved to be a relevant element in the analysis of the profile of women in the situation of abortion. In this study, in both types of abortion, the majority of cases occurred among multiple women. This finding contradicts the results of a study conducted in Mexico, according to which the chances of miscarriage decrease from the second gestation 16. On the other hand, it differs from the data of a study conducted in a hospital in Iraq, specifically focused on cases of missed miscarriage, in which it was found that more than 50% of women were primiparas2. Similarly, in China, it was identified as a risk factor for the occurrence of abortion, having only had one pregnancy17.
Another aspect to be considered is the history of abortions. The literature points out that those with a previous abortion in the first trimester present a risk of recurrence between 12% and 14%. This risk rises to approximately 26% after two gestational losses and can reach 45% after three consecutive abortions18. However, the data from this study show that the majority of participants, regardless of the type of abortion, did not have a history of gestational losses, which differs from the profiles traditionally described. These contrasts suggest that the association between parity and abortion may take different configurations, reinforcing the need for more in-depth and sensitive investigations into these specifics.
The association observed between abortion and lower levels of education may be related to the barriers faced by women with less access to information, sexual and reproductive education, and health services19. This condition can delay the detection of fetal abnormalities or hormonal changes20. However, this pattern does not manifest uniformly across contexts. For example, a study conducted in the Puglia region in Italy found that the majority of women who experienced abortion episodes had a full high school 21. Such disparity evidences that the relationship between schooling and abortion is mediated by contextual determinants.
Additionally, the data from this research indicate a correlation between abortion withholding and higher levels of education, with the predominance of women with higher education. A similar result was identified in a cross-sectional study conducted in Iraq, with 77 women who underwent this type of abortion2. These findings suggest that educational and social factors can influence both access and demand for medical care, as well as the greater ability to recognize signs and symptoms associated with gestational risk conditions, varying depending on the type of abortion.
In this study, the statistically significant association observed between age and type of abortion deserves attention. Missed miscarriage were more common among adolescents under the age of 15 and women aged 35 or older, both classified as gestational risk groups3. In the case of adolescents, in addition to physical risks, psychosocial aspects are highlighted, such as poor preparation to assume maternal responsibilities, the negative impact on school trajectory, incomplete biological development, and less adherence to prenatal follow-up19.
These factors are closely related to the hormonal instability characteristic of this stage of life, especially as regards the levels of human chorionic gonadotropin, estradiol, and progesterone, hormones essential for the maintenance of pregnancy. Changes or insufficient levels of these substances may act as predictors of retentive abortion22. The absence of adequate prenatal monitoring contributes to the inclusion of women in statistics of higher reproductive risk, which may partly explain the association observed in this research.
For women aged 35 years or older, the risks associated with missed miscarriage are primarily influenced by the difficulty of fertilization due to the decrease in the quantity and quality of the eggs with age, which impacts the viability of a healthy pregnancy23. In addition, unhealthy lifestyles, often associated with this age group, can also contribute to increased risk of miscarriage7. The relationship with the hormone predictors of missed miscarriage becomes even more relevant in this group, since the proximity of menopause can provoke greater hormonal instability and less production of hormones essential to gestation17.
In the cases of miscarriage, although it is generally associated with late pregnancy 20, its predominance in women aged between 16 and 34 years, observed in this study, shows consistency with what is described in other research. It should be noted that although fertility is higher in this period, the risks remain significant and they are not confined to economic, social, and cultural barriers, but also include factors such as absence of preventive tests, lack of anti-tetanic vaccination, recent hospitalizations 24, paternal age over 40 years, 25, prior abortions, 26, and anatomical changes, 27.
In this study, the civil status did not present statistically significant differences, and in both types of abortion, the majority of women did not have a mate. A similar result was recorded in Spain24. On the other hand, studies conducted in the region of Puglia, Italy, and the metropolitan region of Santiago, Chile, identified a higher proportion of women with partner 21, 25. These variations suggest that marital status can influence gestational care, especially in terms of access to health services and emotional and social support during pregnancy. Women without a partner may face additional difficulties in accessing medical care on a timely and continuous basis, as well as being more exposed to psychosocial factors that negatively impact maternal health28.
It is hypothesized that the civil status, by itself, does not constitute a determining factor for the occurrence of spontaneous or missed miscarriage. Such outcomes result from a complex set of elements, which include, among other things, the socioeconomic conditions, the social insertion of women, and the timely and qualified access to health services. Still, the findings in the literature reinforce the need for care strategies that consider expanded support networks, beyond the conjugal core, especially in contexts of greater social vulnerability,10,14,21.
Regarding the municipality of residence, no statistically significant associations were observed between population size (small or medium) and types of abortion, suggesting that the simple territorial categorization is not sufficient to explain the reproductive outcomes.
Early miscarriage, defined as one that occurs up to 12 weeks and 6 days of gestation4, was the most frequent in both types. However, it is important to consider that in cases of miscarriage, the estimation of gestational age may have been made based on the date of the last menstruation or by means of ultrasound examination. This methodological variation may generate discrepancies in the records29 and, consequently, affect the accuracy of the collected data and, consequently, have interfered with the analysis of the results of this research.
Regarding gestational age, although no statistically significant association was identified, a subtle difference was observed between the groups, with slightly higher numbers of missed miscarriage occurring less than 13 weeks of gestation. This result is consistent with the literature, which points to a progressive reduction in the risk of gestational loss as the pregnancy progresses to 14, plus a higher incidence of abortions between the sixth and tenth weeks of gestation, with a gradual decrease in subsequent weeks, 26. Such evidence reinforces that, as with the other variables analyzed, abortion-related outcomes should not be understood separately, but in the light of a set of interdependent factors, including social, economic, cultural, and care determinants.
Until 2021, there was a national trend of decreasing the number of abortions and hospitalizations associated with this condition, 13, 26, 30. This decline was therefore expected to continue in subsequent years. However, the data from this study indicate an increase in the cases of spontaneous abortion in general and the withholding of abortion in the years 2022 and 2023. This growth may be related to multiple factors, including the improvement of diagnostic methods, increased awareness of women and professionals about the signs and symptoms of missed miscarriage, as well as possible impacts of changes in socioeconomic conditions and in the organization of health care. In this context, the role of the COVID-19 pandemic is highlighted, which may have disrupted the regularity of prenatal monitoring and contributed to the deterioration of reproductive outcomes, especially among populations at greater vulnerability.
The possible limitations of this study are related to the use of secondary data, from electronic records, subject to register errors, missing data, or inconsistencies that the researcher cannot correct. In addition, the standardized structure of the records in the medical records made it impossible to access information related to clinical, social, or behavioral variables that could favor the deepening and understanding of the cases analyzed.
CONCLUSION
The findings of this study point out that sociodemographic factors, such as schooling and maternal age, significantly influence the types of abortion, revealing inequalities that pervade the reproductive process. There was a higher incidence of spontaneous abortions among women with a lower level of education, while the missed miscarriages were more frequent among those with a higher level of education. Adolescents and women aged 35 or older were more vulnerable to missed miscarriage, reflecting biological, social, and care challenges that affect these age groups in a differentiated way.
By highlighting structural inequalities, the study’s results offer relevant contributions to women’s health within the SUS and have the potential to guide public health actions. The data reinforce the need to strengthen sexual and reproductive education programs aimed at women with lower education levels, broadening access to qualified information and reproductive planning. Similarly, they highlight the importance of improving obstetric care, with follow-up strategies that are more sensitive to the vulnerabilities of adolescents and women in advanced age groups, considering both hormonal risks and psychosocial aspects characteristic of these groups.
In addition, the study’s findings highlight the importance of incorporating social determinants of health into analyses of reproductive outcomes and point to the need for public policies to promote equity. Priority strategies include providing comprehensive care for women’s health and expanding timely, continuous, and qualified access to health services. It is also recommended to conduct additional research that contextualizes the interaction among biological, social, and care factors to support more effective and sensitive interventions for local realities.
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*
Article extracted from the master’s thesis: “Assistência recebida no contexto hospitalar durante o processo de abortamento: perspectiva de mulheres que vivenciaram a experiência”, Universidade Estadual de Maringá, Maringá, PR, Brasil, 2025.
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FUNDING
This study was conducted with the support of the Coordinación de Perfeccionamiento del Personal de Nivel Superior (CAPES) - Financing Code 001.
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HOW TO REFERENCE THIS ARTICLE:
Balestre ME, Pavinati G, da Silva AI, Logullo VV, Teston EF, de Almeida JCG, et al. Spontaneous abortions and missed miscarriage in a public hospital: maternal and sociodemographic profile. Cogitare Enferm [Internet]. 2026 [cited “insert year, month and day”];31:e100981en. Available from: https://doi.org/10.1590/ce.v31i0.100981en
Data availability:
The authors declare that the data can be made available upon request to the corresponding author.
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Associate editor:
Dra. Luciana de Alcantara Nogueira
