流产的主要症状是在孕 22 周前阴道出血,多达 30% 的妊娠可能以流产结束。[4]Makrydimas G, Sebire NJ, Lolis D, et al. Fetal loss following ultrasound diagnosis of a live fetus at 6-10 weeks of gestation. Ultrasound Obstet Gynecol. 2003;22:368-372.http://www.ncbi.nlm.nih.gov/pubmed/14528471?tool=bestpractice.com[5]Ellish NJ, Saboda K, O'Connor J, et al. A prospective study of early pregnancy loss. Hum Reprod. 1996;11:406-412.http://www.ncbi.nlm.nih.gov/pubmed/8671233?tool=bestpractice.com[6]Regan L, Rai R. Epidemiology and the medical causes of miscarriage. Ballieres Best Pract Res Clin Obstet Gynaecol. 2000;14:839-854.http://www.ncbi.nlm.nih.gov/pubmed/11023804?tool=bestpractice.com[7]Moore J, Shillito TJ, Walker JJ. Current issues in management of miscarriage and early pregnancy bleeding. Hosp Med. 2002;63:134-135.http://www.ncbi.nlm.nih.gov/pubmed/11933813?tool=bestpractice.com[8]Farr SL, Schieve LA, Jamieson DJ. Pregnancy loss among pregnancies conceived through assisted reproductive technology, United States, 1999-2002. Am J Epidemiol. 2007;185:1380-1388.http://www.ncbi.nlm.nih.gov/pubmed/17351291?tool=bestpractice.com大多数流产见于妊娠前期,<3% 发生在妊娠中期。[9]Topping J, Farquharson RG. Spontaneous miscarriage. In: Edmonds DK, ed. Dewhurst's textbook of obstetrics and gynaecology. Oxford, UK: Blackwell Publishing. 2007:94-99.
从 1990 年至 2000 年,美国的 6,401,000 例妊娠中估计有 1,030,000 例 (16%) 发生自发性胎儿丢失。[10]Ventura SJ, Abma JC, Mosher WD, et al. Estimated pregnancy rates for the United States, 1990-2000: an update. Natl Vital Stat Rep. 2004;52:1-9.http://www.ncbi.nlm.nih.gov/pubmed/15224964?tool=bestpractice.com没有理由认为其他地区的自然流产总体发生率有显著不同,最近瑞典的一项以人群为基础的前瞻性队列研究发现 12% 的妊娠发生临床流产。[11]Blohm F, Friden B, Milsom I. A prospective longitudinal population-based study of clinical miscarriage in an urban Swedish population. BCOJ. 2007;115:176-183.http://www.ncbi.nlm.nih.gov/pubmed/18081599?tool=bestpractice.com然而,着床后未被识别的妊娠自发丢失比例估计高达 31%。[12]Wilcox AJ, Weinberg CR, O'Connor JF, et al. Incidence of early loss of pregnancy. N Engl J Med. 1988;319:189-194.http://www.ncbi.nlm.nih.gov/pubmed/3393170?tool=bestpractice.com与同一伴侣的复发性流产在其他方面健康的妇女中占 0.5% 至 2%。[13]Buckett W, Regan L. Sporadic and recurrent miscarriage. In: Shaw RW, Soutter WP, Stanton SL, eds. Gynaecology. 3rd ed. London, UK: Churchill Livingstone/ Elsevier Science; 2003:343-359.
由于缺乏研究,因而无法判断是否存在与流产相关的季节性变化;然而,流产趋势可能与自然受孕的季节性相关。一项研究发现,受孕概率的月分布呈现双峰模式,十二月和三月最低,九月和一月最高。[14]Rizzi EL, Dalla-Zuanna G. The seasonality of conception. Demography. 2007;44:705-728.http://www.ncbi.nlm.nih.gov/pubmed/18232207?tool=bestpractice.com在指导妇女在围受孕期采取有益的行为和药物使用时,这种信息可能有用。