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, and a haemodynamically unstable woman needs emergency admission rather than a routine appointment.
| Type | Key features | Cervical os / 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
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