Background: Missed miscarriage is very common complication, which affects about 15% of all clinically recognized pregnancies. The lack of prompt diagnostic biomarkers of missed miscarriage poses a great challenge for clinical implementation. Some authors reported that serum levels of fibroblast growth factor-21(FGF-21) may serve as a potential biomarker for the early recognition of missed miscarriage. Aim of study: To evaluate the role of FGF-21 as a biomarker for the missed miscarriage. Patients and Methods: A case control study that was carried out in the Department of Obstetrics and Gynecology during a period (January – September )2021. It included 100 pregnant women between 7 - 13 weeks of gestation with singleton pregnancy. They were divided into two groups: Case group included 50 pregnant women who presented with vaginal bleeding for the prior 12 hours and diagnosed as missed miscarriage and control group included 50 pregnant women with viable fetuses, matched with the other groups in age and gestational age. Four ml of venous peripheral blood was taken from each woman to test for FGF-21 biomarker. Results: In this study, women with missed miscarriage had significantly higher mean of fibroblast growth factor-21 compared with controls. FGF-21 level > 93.32 pg/ml is a predictor for missed miscarriage. Statistically significant weak negative correlation was detected between FGF-21 level and age. Conclusion : FGF-21biomarker represents a non-invasive, early, fast and excellent predictor of missed miscarriage which can be used if confirmed by further studies.

Keywords: Missed miscarriage, biomarkers, fibroblast growth factor-21: FGF-21, pregnancy, Iraq.