This guideline covers diagnosing and managing ectopic pregnancy and miscarriage in women with complications, such as pain and bleeding, in early pregnancy (that is, up to 13 completed weeks of pregnancy). It aims to improve how early pregnancy loss is diagnosed, and the support women are given, to limit the psychological impact of their loss.
For information on related topics, see our women's and reproductive health summary page.
In August 2023, we reviewed the evidence and made new and updated recommendations on medical management of miscarriage.
This guideline includes new and updated recommendations on:
It also includes recommendations on:
- using ultrasound scans for diagnosis of tubal ectopic pregnancy
- expectant management
- support and information giving
- early pregnancy assessment services
- symptoms and signs of ectopic pregnancy
- diagnosis of viable intrauterine pregnancy and ectopic pregnancy
- management of ectopic pregnancy
Who is it for?
- Healthcare professionals
- Women with complications in early pregnancy (up to 13 completed weeks of pregnancy), their families and carers
Guideline development process
This guideline was developed by the National Guideline Alliance (NGA) which is hosted by the Royal College of Obstetricians and Gynaecologists (RCOG). This guideline was developed with complete independence from RCOG governance.
This guideline updates and replaces NICE guideline CG154 (December 2012).
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.