The aetiology of idiopathic preterm labour remains obscure. The hypothesis that a stress response induced by low-grade bacterial infection in utero-placental tissues was investigated. Distribution of cognate and inducible isoforms of heat shock proteins (HSP) 70 kD, HSP 60 kD and HSP 90 kD were investigated in an immunohistochemical study of placental and decidual tissues before and after labour at varying gestations. Subjects were pregnant women undergoing singleton delivery after idiopathic preterm labour at less than 34 weeks’ gestation (n = 23); spontaneous term labour at 37–42 weeks’ gestation (n = 24); preterm caesarean sections at less than 34 weeks’ gestation for pre-eclampsia or intrauterine growth retardation (n = 14); elective caesarean section at 37-42 weeks’ gestation for cephalopelvic disproportion (n = 6). HSP expression was constant throughout the third trimester of pregnancy and did not change following the onset of labour, regardless of gestational age. A stress response in decidual tissues as determined by immunohistochemical analysis is apparently not associated with preterm labour.

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Key content • Miscarriage has traditionally been treated by surgical evacuation, on the assumption that any retained tissue increases the risk of infection and haemorrhage. • Over the last decade, effective non‐surgical alternatives have been advocated to minimise unnecessary surgical intervention while maintaining low rates of morbidity and mortality. • Improved access to early pregnancy assessment units and greater awareness among women has led to increasing demand for more conservative management of miscarriage. Learning objectives • To learn about the use of appropriate miscarriage terminology. • To learn about the advantages and disadvantages of expectant, medical and surgical management. • To understand that women's choice is paramount in planning treatment. Ethical issues • Guidance on the sensitive disposal of fetal remains is essential. Please cite this article as: Sagili H, Divers M. Modern management of miscarriage. The Obstetrician & Gynaecologist 2007;9:102–108.

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