NICE consults on draft guideline to improve care of women at risk of miscarriage or ectopic pregnancy

The National Institute for Health and Care Excellence (NICE) is today (22 June) launching a consultation on a new draft guideline which, when published, will help the NHS in England and Wales provide consistent, effective, high-quality care for pregnant women experiencing pain or bleeding in early pregnancy (before 13 weeks gestation), or who may have an ectopic pregnancy[1].

Every year, around one in five pregnant women will experience some form of pain or bleeding in early pregnancy. While the majority will go on to have a successful pregnancy, for others the symptoms could indicate an impending miscarriage. Pain or bleeding can also be associated with ectopic pregnancy, although not all women with an ectopic pregnancy will experience these symptoms. NICE is developing its first ever NHS guideline on this sensitive subject and, as part of this process, is encouraging charities, patient groups, NHS organisations and others to register their interest and take part in the consultation by submitting their comments on the draft recommendations, thereby helping to develop the final guideline.

Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said: “When a pregnant woman experiences pain or bleeding in early pregnancy, it can be a very frightening time. It's vital she receives sensitive, timely and effective care and support, especially if she goes on to lose her baby, either through miscarriage or an ectopic pregnancy. Ectopic pregnancies can also be potentially life-threatening for the mother if they aren't diagnosed and managed effectively. Unfortunately at the moment, standards can vary across the country and some women may not be receiving optimum care, particularly those who have an ectopic pregnancy but do not exhibit obvious signs of pain or bleeding.

“The draft version of our guideline on the assessment and management of pain and bleeding in early pregnancy is now subject to a consultation phase and we welcome comments from groups who have registered an interest in this guideline. All feedback will help us develop an effective guideline. Once published, it will ensure the NHS across England and Wales can consistently deliver a high level of care and support to pregnant women and their families.”

Recommendations on which NICE is asking organisations and other stakeholders to comment include:

  • Signs and symptoms of ectopic pregnancy: Be aware that atypical presentation for ectopic pregnancy is common and that ectopic pregnancy can present with a variety of symptoms and signs (as set out in the draft guideline). All healthcare professionals involved in the care of women of reproductive age should have access to pregnancy tests.
  • Specialist assessment service: A dedicated early pregnancy assessment service (where scanning and decision making about management can be carried out), should be available for women with pain and/or bleeding in early pregnancy.
  • Ultrasound for determining a viable intrauterine pregnancy: Women with pain and/or bleeding should be offered a transvaginal ultrasound (TVU) to identify the location of the pregnancy and presence of a fetal pole[2] and heartbeat. If a TVU is not acceptable, a transabdominal ultrasound (TAU) should be offered as an alternative.
  • Management of miscarriage: Expectant management for 7-14 days should be the first line management strategy following confirmed diagnosis of a non-viable pregnancy.
  • Psychological support: Healthcare professionals providing care for women with early pregnancy complications in any setting should be aware that early pregnancy complications can cause significant distress for some women and their partners. Healthcare professionals providing care for these women should be given training in sensitive communications and breaking bad news.

Groups with a registered interest in this guideline have until Friday 17 August 2012 to comment on the draft recommendations. Following this, development on the guideline will continue with recommendations likely to change depending on feedback received during the consultation.


Notes to Editors

  • The draft guideline on pain and bleeding in early pregnancy is available to view from the NICE website from Friday 22 June 2012. Please contact the press office for an embargoed copy of the draft guideline.
  • The guideline focuses on the treatment and care of women who experience any form of pain or bleeding in the first 13 weeks of pregnancy, women who are found to have had a missed miscarriage (confirmed via an ultrasound scan) despite no obvious symptoms, and women who are likely to have an ectopic pregnancy but do not display overt signs of pain or bleeding.
  • The guideline does not make recommendations about pain or bleeding in expectant mothers after the first 13 weeks of pregnancy. It also does not cover unusual conditions that present with pain and bleeding or the issue of recurrent miscarriage, because these require more specific investigation, management and treatment.
  • Only patient groups and organisations that have registered as a stakeholder for this guideline can submit comments during the consultation period. Organisations can register at any time during the development of the guideline and comments must be submitted via the NICE website.
  • This guideline is expected to publish towards the end of 2012.

About NICE

1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health

2. NICE produces guidance in three areas of health:

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

3. NICE produces standards for patient care:

  • quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
  • Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research andinformation to help health professionals deliver the best patient care through NHS Evidence.

[1] An ectopic pregnancy occurs when the fertilised egg, or ovum, lodges in the fallopian tube rather than the uterus and begins to develop.

[2] The term, fetal pole, refers to the growing embryo and is the point at which the fetus becomes visible on an ultrasound scan. This normally happens when the woman is five to six weeks into her pregnancy.

This page was last updated: 21 June 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.