Miscarriage

🔍 When to Suspect

A woman with a confirmed or possible pregnancy presenting before 24 weeks gestation with vaginal bleeding and/or lower abdominal pain or cramping

From the full topic in The Ocean Library: Miscarriage

🧭 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

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