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, 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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