1. Spontaneous abortion, miscarriage and early pregnancy loss:
A bibliometric analysis of PubMed usage
Amanda Ross-White, MLIS, AHIP
Background
Medical Subject Headings (MeSH) are terms used by the National Library of Medicine to index the medical and scientific literature. Terms and their definitions are developed by experts in the field, but are not without controversy as definitions and meanings of words change over time and can have geographical differences[1].
Within the field of librarianship, there is a history of activist cataloguing, which seeks to use subject headings to change perception of terms or issues, such as Sanford Berman’s move to change Library of Congress Subject Headings[2, 3]. The current term for Abortion, Spontaneous is defined as: “Expulsion of the product of FERTILIZATION before completing the term of GESTATION and without deliberate interference[4].”
In 2013, Andrew Moscrop published an analysis of the terms miscarriage and spontaneous abortion in the British medical literature which demonstrated a movement away from the term spontaneous abortion and towards the term miscarriage as a more patient-friendly and empathetic way of describing this significant event[5].
This research sought to determine whether this change was true more broadly by looking at all English-language literature in PubMed with a goal to petitioning the National Library of Medicine for a change in terminology that reflects this usage.
The U.S. National Library of Medicine on the campus of the National Institutes of Health in Bethesda, Maryland. Image is in the public domain.
Methods
Searching only the abstract and title fields to avoid influence from the MeSH terms, I searched the three terms described as follows:
“spontaneous abortion*” [AB] OR [TI]
“miscarriage*” [AB] OR [TI]
“early pregnancy loss*” [AB] OR [TI]
These were then limited to only articles in English given the check tag “Human” to avoid veterinary and theoretical articles. All searches were conducted on June 20, The results were exported into an EndNote database for analysis.
Mrs. Malterud at a card catalog interior of National Library of Medicine. c [1948] image is in the public domain.
Results
Despite Abortion, Spontaneous being the MeSH term in place since 1963, more articles use the term miscarriage. Total retrieval numbers for the three terms are miscarriage with 9951, spontaneous abortion with 7687 and early pregnancy loss with only 915 results. Spontaneous abortion remained the preferred term in the medical literature until 1999 at which time the term miscarriage became more common.
These results varied when sorted by the institution of the primary author. UK and Ireland-based authors moved to the term miscarriage consistently earlier than authors based in the United States. Early pregnancy loss is a term that is growing but remains marginal in the medical literature. .
Conclusion
Moscrop’s analysis of three major British medical journals suggested the change was made in 1985/6, at least for The Lancet and BJOG, with obstetrical textbooks and the BMJ being slower to change[5]. This analysis suggests that for the overall English language the change was more gradual.
Given the change in terminology over time across the English language, the National Library of Medicine has agreed to change their Medical Subject Heading of Abortion, Spontaneous to Miscarriage. This change will take place in January 2018.
But as the NLM is continually behind current language usage, it remains to be seen if miscarriage is the preferred term used by women themselves. As actress Melissa Rauch wrote in an article for Glamour magazine: “"Miscarriage" by the way, deserves to be ranked as one of the worst, most blame-inducing medical terms ever. To me, it immediately conjures up an implication that it was the woman’s fault, like she somehow “mishandled the carrying of this baby.” F that so hard, right in its patriarchal nut-sack. It’s not that a better name would make it less awful to go through.”[6] As the language continues to evolve, there may be future changes to official terminology.
References
1. Dreger A: Monsters and the Ghosts of PubMed. Atrium: The Report of the Northwestern Medical Humanities and Bioethics Program 2012(10).
2. Berman S: Prejudices and Antipathies: A Tract on the LC Subject Heads concerning People. Metuchen, NJ: Scarecrow; 1971.
3. Knowlton SA: Three Decades Since Prejudices and Antipathies: A Study of Changes in the Library of Congress Subject Headings. Cataloging & Classification Quarterly 2005, 40(2):
4. Abortion, Spontaneous [
Moscrop A: 'Miscarriage or abortion?' Understanding the medical language of pregnancy loss in Britain; a historical perspective. Med Humanit 2013, 39(2):
Rauch M. Actress Melissa Rauch Announces Her Pregnancy and Reflects on the Heartache of Miscarriage. Glamour magazine [online]. Retrieved July 12, 2017.
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