Tabrez Ali
Jinnah Sindh Medical University , PakistanPresentation Title:
Consensus statements for assessment, evaluation, and management of threatened miscarriage during the first trimester in Pakistan: A three step modified delphi based study
Abstract
Objective: To develop expert consensus on the risk assessment, diagnosis, and management of threatened miscarriage during the first trimester, tailored to clinical realities in Pakistan.
Methods: A modified three-step Delphi process was conducted with eleven senior obstetricians and gynecologists. Consensus was defined as ≥75% agreement per statement.
Results: Key risk factors included maternal age ≥35, history of ≥2 miscarriages, trauma, and infections such as malaria and COVID-19—both relevant in Pakistan’s epidemiological landscape. Endocrine disorders, thrombophilia (including acquired forms), and modifiable lifestyle factors were unanimously agreed upon. Experts emphasized culturally sensitive patient education to address behavioral risks. Diagnosis was structured into three domains: physical examination, imaging, and laboratory testing. Vaginal speculum exam was prioritized to assess bleeding severity. Transvaginal ultrasound (TVS) was recommended to evaluate fetal viability, gestational sac characteristics, subchorionic hematoma, and rule out ectopic pregnancy. Lab tests included hCG (serial or single, based on ultrasound), complete blood count, Rh typing, and thrombophilia screening in select cases. Management consensus was limited. Follow-up was universally endorsed. Notably, oral Dydrogesterone emerged as a preferred therapeutic option, supported by both international evidence and local clinical experience. Studies show Dydrogesterone significantly reduces miscarriage risk compared to placebo and vaginal progesterone. Its safety profile and ease of administration make it particularly suitable for resource-constrained settings like Pakistan.
Conclusion: This is the first Delphi-based expert consensus on threatened miscarriage in Pakistan. It provides contextspecific guidance for risk stratification, diagnosis, and management, and supports Dydrogesterone as a viable treatment option. The findings aim to improve clinical consistency and patient education in early pregnancy care.
Biography
Tabrez Ali, MD, MSc, MBA, is an accomplished medical affairs leader currently serving as an Associate Director of Medical Affairs. He holds a Master of Science from the University of Aberdeen, where his commendable thesis investigated biomarkers in breast cancer, forming a strong foundation in clinical research. Dr. Ali's professional focus is firmly rooted in advancing public health outcomes through evidence-based medicine. His career is distinguished by significant contributions to a broad spectrum of clinical research. This includes hands-on leadership in managing bioequivalence (Phase I) and interventional trials for essential medicines, as well as contributing to large-scale observational studies and disease registries in areas such as hepatology, women's health, and infectious diseases. His work ensures that scientific rigor is applied from the earliest stages of drug development to real-world application. Beyond clinical trials, Dr. Ali has been instrumental in developing national medical guidelines, such as the Pakistan Influenza Consensus, and has a proven track record of disseminating complex scientific data to healthcare professionals through innovative digital platforms and international symposia. His unique blend of clinical acumen, strategic medical affairs expertise, and a deep-seated commitment to public health enables him to effectively bridge the gap between clinical research, medical strategy, and improved patient care.
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