Temporal and socioeconomic trends in hospital admissions for miscarriage and ectopic pregnancy in England, 2004-2024: a nationwide study.

BACKGROUND: Miscarriage and ectopic pregnancy are among the most common early pregnancy complications, yet contemporary national trends and associated inequalities in England remain poorly characterised. This study examined 20-year temporal patterns in hospital admissions for miscarriage and ectopic pregnancy, with additional stratification by socioeconomic deprivation and age. METHODS: National admissions data from 2004 to 2024, curated by NHS England, were extracted from Hospital Episode Statistics and the Maternity Services Data Set. Annual counts of miscarriage (ICD-10 O02-O03) and ectopic pregnancy (ICD-10 O00), deliveries, deprivation deciles, and age groups were analysed. Joinpoint regression (version 5.0) was used to identify significant changes in trends, calculating Annual Percent Change (APC) and Average Annual Percent Change (AAPC). FINDINGS: Miscarriage admissions declined significantly between 2018 and 2021 (APC = -4.44∗%; 95% CI: -7.4218 to -0.7135; p = 0.03), followed by a modest rise after 2021 (APC = +2.823%; 95% CI: -1.8311 to 8.8970; p = 0.13). Ectopic pregnancy admissions increased significantly up to 2012 (APC +2.82%; 95% CI: 1.3845-3.8309; p = 0.007), declined with the introduction of conservative management guidelines (APC = -2.97%; 95% CI: -3.9393 to 3.827; p = 0.15) and rose again after 2021 (APC = +4.23∗% (95% CI: 2.1194-7.1943; p < 0.001). A persistent deprivation gradient was observed, with the most deprived deciles consistently experiencing the highest admissions (around two-fold difference). The proportion of admissions among women aged 25-34 years increased (approximately 40-50%) for both outcomes. INTERPRETATION: Persistent socioeconomic inequalities reflect a combination of population structure, higher prevalence of modifiable risk factors and inequitable access to care. Strengthening equitable access, tailored outreach through digital platforms and preventive strategies addressing modifiable risk factors may help optimise early pregnancy care and reduce avoidable emergency admissions. Findings should be interpreted with caution due to limited risk factor, parity, and age-deprivation data. FUNDING: None.