Quality statement 3: Confirming a diagnosis of miscarriage

Quality statement

Women with a suspected miscarriage who have had an initial transvaginal ultrasound scan are offered a second assessment to confirm the diagnosis.

Rationale

A single transvaginal ultrasound scan may not always accurately diagnose miscarriage, and so a second assessment should be offered to confirm the diagnosis in women with suspected miscarriage. Treatment for miscarriage should not start until the site and viability of the pregnancy have been confirmed by a second assessment.

Quality measures

Structure

Evidence of local arrangements to ensure that women with a suspected miscarriage who have had an initial transvaginal ultrasound scan are offered a second assessment to confirm the diagnosis.

Data source: Local data collection.

Process

Proportion of women with a suspected miscarriage who have had an initial transvaginal ultrasound scan and are offered a second assessment to confirm the diagnosis.

Numerator – the number in the denominator who receive a second assessment to confirm the diagnosis.

Denominator – the number of women with a suspected miscarriage who have had an initial transvaginal ultrasound scan.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (secondary care services) ensure that procedures and protocols are in place for women with a suspected miscarriage who have had an initial transvaginal ultrasound scan to be offered a second assessment to confirm the diagnosis.

Healthcare professionals (such as consultant obstetricians, gynaecologists and ultrasonographers) offer women with a suspected miscarriage who have had an initial transvaginal ultrasound scan a second assessment to confirm the diagnosis.

Commissioners (clinical commissioning groups for secondary care) ensure that they monitor service providers to make sure they are offering second assessments to women with a suspected miscarriage who have had an initial transvaginal ultrasound scan to confirm the diagnosis.

Women with a suspected miscarriage who have had a transvaginal ultrasound scan (where a small probe is inserted into the vagina) are offered a second assessment to confirm the diagnosis. This may involve a second opinion from another healthcare professional and/or a second scan 1 or 2 weeks after the first.

Source guidance

Ectopic pregnancy and miscarriage: diagnosis and initial management (2019) NICE guideline NG126, recommendations 1.4.6, 1.4.7, 1.4.9 and 1.4.10

Definitions of terms used in this quality statement

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]

Second assessment

Confirming a diagnosis of miscarriage with a second assessment is outlined in NICE's guideline on ectopic pregnancy and miscarriage, recommendations 1.4.6, 1.4.7, 1.4.9 and 1.4.10. This includes seeking a second opinion on the viability of the pregnancy and/or offering a repeat transvaginal ultrasound scan at either a minimum of 7 days or a minimum of 14 days after the initial scan to confirm diagnosis (depending on the clinical situation).

Equality and diversity considerations

When offering a repeat 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.