GPAtlas🧭 When to suspect
Suspect miscarriage in any woman with a confirmed pregnancy – or who could be pregnant – presenting before 24 weeks gestation with vaginal bleeding and/or lower abdominal pain or cramping.
A quieter clue is the loss of pregnancy symptoms (settling nausea or breast tenderness), which may be the only feature of a missed miscarriage.
Miscarriage is the most common complication of early pregnancy, affecting around 15% of recognised pregnancies; the true figure is higher, as many losses occur before the pregnancy is recognised.
The two non-negotiable skills in primary care are to exclude ectopic pregnancy and to assess haemodynamic stability.
• Any woman of reproductive age with a positive pregnancy test and pain or pelvic tenderness has an ectopic pregnancy until proven otherwise.
• A haemodynamically unstable woman needs emergency admission rather than a routine appointment.
| Type | Key features | Cervical os and scan |
|---|---|---|
| Threatened | • Bleeding with a viable intrauterine pregnancy • Pain mild or absent |
• Os closed • Fetal heartbeat present |
| Inevitable | • Bleeding and pain • Miscarriage is in progress |
• Os open • Products not yet passed |
| Incomplete | • Some products passed, some retained • Ongoing bleeding/pain |
• Os often open • Retained products on scan |
| Complete | • All products passed • Bleeding and pain settling |
• Os closed • Empty uterus on scan |
| Missed (delayed) | • Fetus has died but is retained • Often little/no bleeding and loss of pregnancy symptoms |
• Os closed • No heartbeat on scan |
| Septic | Retained products with infection – fever, rigors, offensive discharge, tender uterus | A surgical emergency |
Source: NICE NG126
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.