Surveillance decision

Surveillance decision

We will plan an update of the guideline on ectopic pregnancy and miscarriage. The update will focus on the accuracy of ultrasound for diagnosing ectopic pregnancy.

An extension to the scope will be needed to incorporate a new review question about the effectiveness of expectant management compared to medical management for ectopic pregnancy.

A change in the title of the NICE guideline will be needed to make clear that the guideline only refers to tubal ectopic pregnancy rather than any type of ectopic pregnancy.

Reason for the decision

Assessing the evidence

We found 30 studies through surveillance of this guideline.

Evidence that could affect recommendations was identified. Topic experts, including those who helped to develop the guideline, advised us about whether the following sections of the guideline should be updated and any new sections added:

Diagnosis of viable intrauterine pregnancy and of ectopic pregnancy
  • New review question – What ultrasound features are most diagnostic of an ectopic pregnancy?

Stakeholders highlighted that ultrasound criteria to make a diagnosis of ectopic pregnancy might improve care for women experiencing early pregnancy loss and that NICE guideline CG154 does not discuss such criteria. There was also evidence from a systematic review and meta-analysis that an empty uterus, a pseudosac, adnexal mass or free fluid in an ultrasound might be useful for 'ruling in' a tubal pregnancy. Therefore, it was considered to update recommendations 1.4.1 to 1.4.17 which currently do not include diagnostic criteria for ectopic pregnancy.

Decision: This review question should be added.

Expectant management of ectopic pregnancy
  • New review question – How effective is expectant management compared to medical management for ectopic pregnancy?

During the 3-year surveillance review, the panel of experts suggested that expectant management for ectopic pregnancy may have a place for very early pregnancies that naturally resolve on their own without needing to give a drug with unpleasant side effects to the patient or intervene surgically. However, the panel agreed that further research in this area was needed before considering for inclusion in the guideline. As new evidence has been found during the 4-year surveillance review, recommendations 1.6.1 to 1.6.14 might need to be revised because expectant management is not currently considered as an option for the management of ectopic pregnancy.

Decision: This review question should be added.

We also found evidence that supports current recommendations on:

  • support and information giving

  • management of miscarriage

  • management of ectopic pregnancy.

We did not find any evidence related to:

  • early pregnancy assessment services

  • symptoms and signs of ectopic pregnancy and initial assessment

  • anti-D rhesus prophylaxis.

We found evidence which was not covered in the guideline. However, the evidence was insufficient to add new recommendations in these areas at this time:

  • Medical management of miscarriage in outpatient settings

  • Diagnostic accuracy of serum biomarkers

  • Active treatments for managing non-tubal ectopic pregnancy

  • Single and double dose of methotrexate for ectopic pregnancy.

Equalities

No equalities issues were identified during the surveillance process.

Overall decision

After considering all the evidence and views of topic experts, we decided that a partial update and a modification in scope are necessary for this guideline.

See how we made the decision for further information.


This page was last updated: 23 February 2017