Key priorities for implementation

The following recommendations have been identified as priorities for implementation.

Support and information giving

  • Throughout a woman's care, give her and (with agreement) her partner specific evidence-based information in a variety of formats. This should include (as appropriate):

    • When and how to seek help if existing symptoms worsen or new symptoms develop, including a 24-hour contact telephone number.

    • What to expect during the time she is waiting for an ultrasound scan.

    • What to expect during the course of her care (including expectant management), such as the potential length and extent of pain and/or bleeding, and possible side effects. This information should be tailored to the care she receives.

    • Information about post-operative care (for women undergoing surgery).

    • What to expect during the recovery period – for example, when it is possible to resume sexual activity and/or try to conceive again, and what to do if she becomes pregnant again. This information should be tailored to the care she receives.

    • Information about the likely impact of her treatment on future fertility.

    • Where to access support and counselling services, including leaflets, web addresses and helpline numbers for support organisations.

Ensure that sufficient time is available to discuss these issues with women during the course of their care and arrange an additional appointment if more time is needed.

Early pregnancy assessment services

  • Regional services should be organised so that an early pregnancy assessment service is available 7 days a week for women with early pregnancy complications, where scanning can be carried out and decisions about management made.

Symptoms and signs of ectopic pregnancy and initial assessment

  • During clinical assessment of women of reproductive age, be aware that:

    • they may be pregnant, and think about offering a pregnancy test even when symptoms are non-specific and

    • the symptoms and signs of ectopic pregnancy can resemble the common symptoms and signs of other conditions – for example, gastrointestinal conditions or urinary tract infection.

  • All healthcare professionals involved in the care of women of reproductive age should have access to pregnancy tests.

Using ultrasound for diagnosis

  • Offer women who attend an early pregnancy assessment service (or out-of-hours gynaecology service if the early pregnancy assessment service is not available) a transvaginal ultrasound scan to identify the location of the pregnancy and whether there is a fetal pole and heartbeat.

Human chorionic gonadotrophin measurements in women with pregnancy of unknown location

Expectant management

  • Use 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:

    • 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.

Surgical management

  • Where clinically appropriate, offer women undergoing a miscarriage a choice of:

    • manual vacuum aspiration under local anaesthetic in an outpatient or clinic setting or

    • surgical management in a theatre under general anaesthetic.

Performing laparoscopy

  • When surgical treatment is indicated for women with an ectopic pregnancy, it should be performed laparoscopically whenever possible, taking into account the condition of the woman and the complexity of the surgical procedure.

Salpingectomy and salpingotomy

  • Offer a salpingectomy to women undergoing surgery for an ectopic pregnancy unless they have other risk factors for infertility.

  • National Institute for Health and Care Excellence (NICE)