Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management in Early Pregnancy of Ectopic Pregnancy and Miscarriage

Excerpt

The guideline covers diagnosis of early pregnancy loss, including the use of ultrasound scanning and biochemical testing. Investigations incur costs and the use of serial measurements may delay decision making. The guideline includes guidance on when senior and/or specialist advice should be sought in order to avoid errors and unnecessary delay.

Treatment for threatened miscarriage has been offered by many clinicians over the years, although it is not freely available to all women. Even though progesterone/progestogen is not licensed for this purpose in the UK, it is commonly prescribed in many countries. The guideline examines the evidence for the risks and benefits of this treatment.

The clinical and cost effectiveness of expectant, surgical and medical management for miscarriage and surgical and medical treatment of ectopic pregnancy are considered, with reviews looking at both the risks and benefits of each strategy in terms of clinical and psychological outcomes. Cost effectiveness is an extremely important component of any guideline, in order to ensure that the limited resources of the National Health Service are used to maximise health benefits for its users. The final advice and selection of first line treatment takes this into account.

The guideline does not cover pregnancy after the first trimester (after 12 completed weeks of pregnancy). It also does not deal with unusual conditions that present with pain and bleeding, such as hydatidiform mole, which require a different form of treatment. Similarly, it does not consider recurrent miscarriage, as this requires more specific investigation and management.