Quality statement 2: Ultrasound to identify miscarriage or tubal ectopic pregnancy

Quality statement

Women who are referred with suspected ectopic pregnancy or miscarriage are offered a transvaginal ultrasound scan to identify the location and viability of the pregnancy.

Rationale

An initial ultrasound scan should be performed to diagnose an ectopic pregnancy or assess for miscarriage. A transvaginal ultrasound scan provides the best quality imaging and is more effective than a transabdominal scan because it can offer clearer pictures of the womb, ovaries and surrounding areas. However, a single transvaginal ultrasound scan may not always accurately diagnose miscarriage.

Quality measures

Structure

Evidence of local arrangements to ensure that women who are referred with suspected ectopic pregnancy or miscarriage are offered a transvaginal ultrasound scan to identify the location and viability of the pregnancy.

Data source: Local data collection.

Process

a) Proportion of women who are referred with a suspected ectopic pregnancy and who receive a transvaginal ultrasound scan to identify the location and viability of the pregnancy.

Numerator – the number in the denominator who receive a transvaginal ultrasound scan to identify the location and viability of the pregnancy.

Denominator – the number of women who are referred with a suspected ectopic pregnancy.

Data source: Local data collection.

b) Proportion of women who are referred with a suspected miscarriage and who receive a transvaginal ultrasound scan to identify the location and viability of the pregnancy.

Numerator – the number in the denominator who receive a transvaginal ultrasound scan to identify the location and viability of the pregnancy.

Denominator – the number of women who are referred with a suspected miscarriage.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (secondary care services) ensure that protocols and equipment are in place for transvaginal ultrasound scans to be offered to women with a suspected ectopic pregnancy or miscarriage to identify the location and viability of the pregnancy.

Healthcare professionals (such as consultant obstetricians, gynaecologists and ultrasonographers) offer women with a suspected ectopic pregnancy or miscarriage a transvaginal ultrasound scan to identify the location of the pregnancy and viability of the pregnancy.

Commissioners (clinical commissioning groups for secondary care) ensure that protocols and equipment are in place to offer transvaginal ultrasound for the diagnosis of ectopic pregnancy and miscarriage, and ensure that they monitor the provision of transvaginal ultrasound by relevant service providers.

Women with a suspected ectopic pregnancy (when a fertilised egg is outside the womb) or a suspected miscarriage are offered a scan called a transvaginal ultrasound scan (where a small probe is inserted into the vagina) to check whether the pregnancy is in the womb and if it is continuing.

Source guidance

Ectopic pregnancy and miscarriage: diagnosis and initial management (2019) NICE guideline NG126, recommendation 1.4.1

Definitions of terms used in this quality statement

Suspected ectopic pregnancy

The symptoms and signs of ectopic pregnancy are outlined in NICE's guideline on ectopic pregnancy and miscarriage, recommendations 1.3.3 and 1.3.4.

Suspected miscarriage

Women with bleeding or other symptoms and signs of early pregnancy complications who have:

  • pain or

  • a pregnancy of 6 weeks' gestation or more or

  • a pregnancy of uncertain gestation. [NICE's guideline on ectopic pregnancy and miscarriage, recommendation 1.3.9]

Transvaginal ultrasound scan

In a transvaginal ultrasound scan, a small probe is inserted into the vagina to check whether the pregnancy is in the womb and if it is continuing. The use of transvaginal ultrasound scanning is outlined in NICE's guideline on ectopic pregnancy and miscarriage, recommendations 1.4.5–1.4.7, 1.4.9 and 1.4.10.

Equality and diversity considerations

When offering a transvaginal ultrasound scan, healthcare professionals should provide information about the scan that is sensitive to the woman's religious, ethnic or cultural needs and takes into account whether the woman has learning disabilities, or difficulties in communication or reading. Women provided with information should have access to an interpreter or advocate if needed.

If a transvaginal ultrasound scan is unacceptable to the woman, healthcare professionals should offer a transabdominal ultrasound scan and explain the limitations of this method.

All women should have the option to be examined by a female member of staff if requested. This may be particularly important for women from certain cultural or religious groups.