Miscarriage
Questionnaire/history:
Abdominal or pelvic pain?
Vaginal bleeding with or without clots?
Dizziness, fainting, or syncope?
Shoulder tip pain (ectopic)?
Passage of tissue?
Rectal pressure or pain on defecation?
Past medical history?
Current medication?
Known drug allergies?
Examination:
Blood pressure?
Pulse?
Management:
Haemodynamically unstable?
Immediate ambulance transfer to a hospital without undertaking a pelvic examination
Resuscitate with intravenous fluids, if available
Haemodynamically stable?
Still consider an ectopic
Bleeding and NO abdominal pain and tenderness, pelvic or cervical motion tenderness and
> 6 weeks pregnant (or of uncertain gestation) ectopic pregnancy is still possible, although less likely:
Admission to an early pregnancy assessment unit (EPAU) or out-of-hours gynaecology service depending on the amount of bleeding
< 6 weeks gestation:
Referring to EPAU only if bleeding continues after 6 weeks of gestation or they develop symptoms of an ectopic pregnancy
If bleeding settles before 6 weeks of gestation, repeat a pregnancy test after 7-10 days to determine if they have had a miscarriage and return if positive
Arrange follow up to manage any changes in the clinical situation appropriately
Follow up:
Ensure that arrangements for routine antenatal care are cancelled if they have been started
Discuss any questions she has about her miscarriage
Grief, anxiety, and depression are common following a miscarriage, commonly at its worst for up to 6 weeks
Give information
Reference(s):
Information for patient/carer(s):
Royal College of Obstetricians and Gynaecologists: Early miscarriage: information for you