1. Reporting on Miscarriages in Zaatari and Azraq camp-2016
UNFPA/Jordan

2. Miscarriage Miscarriage (pregnancy loss):
Is the spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving independently, generally defined in humans at prior to 20 weeks of gestation.
Still many countries defined it at prior to 24 weeks (most Arabic countries including Jordan, UK, Italy, Spain). *
The term abortion was replaced by miscarriage since 2005 to describe a spontaneous event.
The term abortion is limited now to iatrogenic termination of pregnancy
*Many countries adopted the 20 weeks because with good baby care units they are having few take home babies. Others sticks to 24 weeks because they do not want to increase their national perinatal mortality rate

3. Types of Miscarriage
Occult miscarriage: Occurs before the women knows that she is pregnant (50% of all pregnancies)
Early pregnancy loss (chemical pregnancy): Spontaneous abortions that occur before the 6th week. Proved by pregnancy test (positive hCG) Account for 15 – 20% of all pregnancies
Clinical pregnancy loss (Clinical pregnancy): Those that occur after the sixth weeks gestation. Proved by ultrasound scan. Account for 8 – 10 % of all pregnancies between 6 – 8 weeks and 2% after that.

4. Data Analysis of Miscarriages at Zaatari and Azraq Camp
Data collected (1st Jan - 31st Dec.2016).
- UNFPA/ JHASi Clinic in Zaatari camp,
- UNFPA/IMC clinic at Azraq camp.
Total number of cases :
Zaatari camp : 210 women
- Azraq camp : 180 women
Documentation in log book
Collection of data from monthly report of Misc. template

5. Distribution of cases by age%
No.
Age (years)
12.9 27
< 18
34.8 73
18-24
52.4
110
> 24
100
210
range:15 – 48 years
Zaatari %
No.
Age (years)
7.2 13
< 18
28.9 52
18-24
63.9
115
> 24
100
180
range:17 – 45 years
This slide indicate that 12.9% were below the age of 18 years. So if the prevalence of early marriage is around 11% then this slide support the evidence of increased incidence of miscarriage among women below the age of 18 years.
Azraq

6. Distribution of cases by parity%
No.
Parity
39.0 82
Low parity (0 – 1)
40.5 85
Multiparity (2 – 4)
20.5 43
Grand multiparity (> 5)
100
210
range: 0 – 12
Zaatari %
No.
Parity
38.3 69
Low parity (0 – 1)
40.6 73
Multiparity (2 – 4)
21.1 38
Grand multiparity (> 5)
100
180
range: 0 – 11
This slide shows that high cases reported among the patients had a low parity in both camps. This may reflect the increased incidence of miscarriage among primigravida and those with low parity. This could be also age related
Azraq

7. Distribution of cases by gestational age
Expected range (%) %
No.
Gestational age (weeks)
15 – 20
30.4 64
Early first trimester (< 7 weeks)
2 – 8
44.3 93
Late first trimester ( 8 – 13 weeks) 1
25.3 53
Second trimester (14 – 24 weeks) -
100
210
range: 4 – 28
Zaatari
Expected range (%) %
No.
Gestational age (weeks)
15 – 20
37.8 68
Early first trimester (< 7 weeks)
2 – 8
45.0 81
Late first trimester ( 8 – 13 weeks) 1
17.2 31
Second trimester (14 – 24 weeks) -
100
180
range: 3 – 27
This side shows an unexpected finding. We all know that the most common cause o miscarriage is chromosomal anomalies (60%), so we should expect that most of our cases should be early pregnancy loss. But this slide shows a high tendency toward late miscarriage. This could be due to under reporting of early miscarriage or there is an environmental causes or another causes that could attribute to this findings.
Azraq

8. Miscarriages in relation to other variables%
NO.
Variables
86.2
181
Planned pregnancy
84.8
178
Booked for ANC
54.8
23.8
15.2
6.2
115 50 32 13
Clinical presentation:
Vaginal bleeding
Abdominal pain
Vaginal spotting
Asymptomatic
Zaatari %
NO.
Variables
73.3
132
Planned pregnancy 75
135
Booked for ANC
69.5
2.2
26.6
1.7
125 4 48 3
Clinical presentation:
Vaginal bleeding
Abdominal pain
Vaginal spotting
Asymptomatic
Azraq

9. Zaatari Azraq Types of miscarriage % No. Types of miscarriage 19.5 41
Threatened
25.7 54
Incomplete
8.1 17
complete
46.7 98
Missed
100
210
Total
Zaatari %
No.
Types of miscarriage
43.9 79
Threatened
8.3 15
Incomplete
26.7 48
complete
21.1 38
Missed
100
180
Total
Azraq

10. Cases with history of previous miscarriage%
No.
Number of previous Miscarriages
17.6 37
One miscarriage 11 23
2 miscarriages
0.9 2
3 miscarriage
0.5 1
5 miscarriages 30 63
Total
Zaatari %
No.
Number of previous Miscarriages
11.1 20
One miscarriage
14.5 26
2 miscarriages 36
3 miscarriage 15 27
4 -5 miscarriages
7.2 13
6 -7 miscarriages
67.8
122
Total
More data need to be collected on recurrent misc.(Habitual abortion)
Is the occurrence of three consecutive spontaneous miscarriages.
Primary recurrent pregnancy loss refers to couples that have never had a live birth,
Secondary recurrent pregnancy loss refers to those who have had repetitive losses following a successful pregnancy
Incidence: 1% of all women
Azraq

11. Distribution of cases in relation to other variables
Zaatari %
No.
Variable
14.3 30
Home
Place of Miscarriage.
85.7
180
Health facility
100
210
Supervision by Skilled personnel
88.1
185
Referral to hospital
30.2 80
Counselling
Post abortion care
41.1 62 FP
Post abortion care : no mention about any management that were provided apart from Counseling and Family planning.

12. Distribution of cases in relation to other variables
Azraq %
No.
Variable 35 63
Home
Place of Miscarriage. 20 36
Health facility 45 81
N/A
100
180
Supervision by Skilled personnel
16.7 30
Referral to hospital
Counselling
Post abortion care FP

13. Recommendations: Improve reporting and data collection.
Revision of the miscarriage template to ensure documentation of Recurrent( Habitual Miscarriage)
Implementation of the template at host communities.
Improve the post abortion care services and family planning counseling

14. THANK YOU