Rethinking Miscarriage: Why Australia’s New Guideline Is a Milestone in Care

Rethinking Miscarriage: Why Australia’s New Guideline Is a Milestone in Care

For the first time, Australia has a national guideline to support clinical care for miscarriage, recurrent miscarriage and ectopic pregnancy. Developed by RANZCOG, the guideline is the first of its kind—bringing clarity and consistency to an area of healthcare where practice has long been fragmented, and where distress is often compounded by uncertainty.

It’s a significant milestone. Early pregnancy loss affects between 10% and 25% of known pregnancies, with most miscarriages happening in the first trimester. Despite this, care has often varied depending on location, provider experience, and local protocols. Some people receive thoughtful, informed care. Others face confusion, delays, or procedures that are out of step with best evidence.

This new guideline changes that. Backed by extensive review and international comparisons, it sets out clear, evidence-based recommendations across expectant, medical and surgical care. Critically, it affirms that people should be offered a choice of management options—alongside clear information and empathetic support.

The guideline also updates the role of progesterone. For women with a history of two or more miscarriages who present with early bleeding, progesterone treatment is now recommended. But for others—including those with no history of loss—there is little evidence of benefit. The clarity this provides will help avoid both overuse and missed opportunities.

Recurrent miscarriage also receives focused attention, with new guidance on when to investigate, which tests are supported by evidence, and how to navigate the limitations of current options. Importantly, it moves away from assumptions and outdated terminology, avoiding phrases like “spontaneous abortion” that many find distressing.

While the guideline is clinical in nature, it doesn’t ignore the emotional toll of early pregnancy loss. It reinforces the need for sensitive communication, informed consent, and pathways to psychological support—especially for those who experience multiple losses or receive care in emergency settings.

The release of this national guideline is a powerful step forward. It brings long-needed consistency to an area that affects thousands of people each year, and recognises that the experience of early pregnancy loss is not just a clinical event, but a deeply personal one. The next challenge is implementation—ensuring that the insights and recommendations don’t stay on paper, but reach the consulting rooms, hospitals and services where they’re needed most.

This is more than a policy shift. It’s a reset in how we think about, talk about, and care for people experiencing early pregnancy loss. And it’s well overdue.