Current NICE guidance [1,2] advises use of expectant management for 7–14 days as the first-line management strategy for women with a confirmed diagnosis of miscarriage. Explore management options other than expectant management if:
- expectant management is not acceptable or
- the woman is at increased risk of haemorrhage (for example, she is in the late first trimester) or
- she has previous adverse and/or traumatic experience associated with pregnancy (for example, stillbirth, miscarriage or antepartum haemorrhage) or
- she is at increased risk from the effects of haemorrhage (for example, if she has coagulopathies or is unable to have a blood transfusion) or
- there is evidence of infection.
Explain what expectant management involves and that most women will need no further treatment (successful for 70-80% patients). Give all women oral and written information about what to expect throughout the process, advice on pain relief and where and when to get help in an emergency. Also provide women with oral and written information about further treatment options – medical or surgical (MVA or under GA). Written consent is not mandatory.
Give an appointment for 2-3 weeks’ time and offer a repeat scan. The patient should then be reviewed at 2-weekly intervals if she continues to opt for conservative management. Consider checking FBC/CRP. If ongoing bleeding and/or positive pregnancy test, the patient needs review and USS. Discuss alternative management options of miscarriage.