SIGNS & SYMPTOMS & INVESTIGATIONS & DIAGNOSIS

SIGNS & SYMPTOMS

• Pelvic/abdominal pain
• Amenorrhoea
• Intermittent bleeding
• Vaginal bleeding
• Abdominal/pelvic/cervical tenderness
• Signs of shock

INVESTIGATIONS & DIAGNOSIS

• Pregnancy test
• Transvaginal ultrasound: diagnostic tool of choice
• Abdominal examination (avoid if abdominal pain is present) TREATMENT PLAN

Immediate A&E if:

• Severe abdominal pain
• Bleeding
• Haemodynamically unstable

Refer to the Early Pregnancy Assessment Unit if:

• Positive pregnancy test with abdominal pain/pelvic tenderness/cervical motion tenderness
• Bleeding plus pain >6 weeks of gestation
• Pregnancy of uncertain gestation Conservative management:
• Suitable if <6 weeks of gestation
• No risk factors
• Bleeding without pain
• Return if: continued bleeding, pain develops Repeat pregnancy test at 7-10 days
• If negative: complete miscarriage confirmed

Secondary care options:

• Medical management
• Surgical management (risks: cervical perforation, Asherman syndrome)

Post-management:

• Anti-D immunoglobulin if RhD negative Follow-up after miscarriage
• Contraception can start:
• <5 days post-miscarriage: no additional barrier protection needed
• >5 days: additional barrier protection required