ORIGINAL RESEARCH article
Front. Med.
Sec. Obstetrics and Gynecology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1669594
A Risk Prediction Model of Spontaneous Miscarriage in Women with Threatened Miscarriage: A Prospective Cohort Study
Provisionally accepted
Chee Wai Ku1,2*
Yu Bin Tan2Marie Min Tse Tan3Sze Ing Tan4Carissa Shi Tong Ng3Jyostna Ramakrishna4Hiu Gwan Chan1,5Thiam Chye Tan1Jerry Kok Yen Chan1,2
See Ling Loy1,2- 1KK Women's and Children's Hospital, Singapore, Singapore
- 2Duke-NUS Medical School, Singapore, Singapore
- 3National University of Singapore Yong Loo Lin School of Medicine, Singapore, Singapore
- 4Lee Kong Chian School of Medicine, Singapore, Singapore
- 5SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
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Introduction: This study aims to develop a holistic risk prediction triage tool for women with threatened miscarriage by integrating clinical, biochemical, and radiological factors. Additionally, we aim to assess the performance of various models incorporating different factor combinations, adaptable for diverse resource settings. Methods: This prospective cohort study included 1,080 women with single intrauterine pregnancies at 5-12 weeks' gestation presenting with threatened miscarriage at KK Women's and Children's Hospital, Singapore between October 2017 and May 2023. Multivariable logistic regression and risk-score models were developed using maternal age, nausea, prior miscarriages, serum progesterone, gestational age, and fetal heart activity. Model performance was assessed via Area Under Receiver Operating Characteristic (AUROC) curve with 10-fold cross-validation. The primary outcome was miscarriage by 16 weeks. Results: The miscarriage rate was 17.3%. Low serum progesterone (<35 nmol/L) was the strongest predictor (odds ratio [OR] 26.3; 95% confidence interval [CI]: 16.6–41.5), followed by absent fetal heart detection (OR 4.05; CI: 2.37–6.92) and increasing maternal age (OR 1.05; CI: 1.00–1.11). Higher gestational age decreased miscarriage risk (OR 0.57; CI: 0.45– 0.73). The integrated model demonstrated high predictive accuracy (AUROC 0.90; CI: 0.87– 0.93). The risk-score model achieved AUROC 0.82, with 80% sensitivity and 84% specificity at cut-off of 2. Discussion: This clinically practical holistic prediction tool enables early identification of women at high risk of miscarriage following threatened miscarriage. It may guide personalized counselling and targeted interventions in both high-and low-resource settings.
Keywords: Threatened miscarriage, Risk prediction model, miscarriage prediction, serumprogesterone, clinical triage tool
Received: 20 Jul 2025; Accepted: 23 Oct 2025.
Copyright: © 2025 Ku, Tan, Tan, Tan, Ng, Ramakrishna, Chan, Tan, Chan and Loy. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Chee Wai Ku, yubin.tan@gmail.com
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