Quality statement 3: Confirming a diagnosis of miscarriage
Quality statement
Women, trans men and non-binary people with a suspected miscarriage who have had an initial transvaginal ultrasound scan are offered a second assessment to confirm the diagnosis. [2014]
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, trans men and non-binary people 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
The following measure can be used to assess the quality of care or service provision specified in the statement. It is an example of how the statement can be measured, and can be adapted and used flexibly.
Process
Proportion of women, trans men and non-binary people 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, trans men and non-binary people with a suspected miscarriage who have had an initial transvaginal ultrasound scan.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
What the quality statement means for different audiences
Service providers (secondary care services) ensure that procedures and protocols are in place for women, trans men and non-binary people 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, trans men and non-binary people with a suspected miscarriage who have had an initial transvaginal ultrasound scan a second assessment to confirm the diagnosis.
Commissioners ensure that they monitor service providers to make sure they are offering second assessments to women, trans men and non-binary people with a suspected miscarriage who have had an initial transvaginal ultrasound scan to confirm the diagnosis.
Women, trans men and non-binary people 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. NICE guideline NG126 (2019, updated 2026), recommendations 1.6.3, 1.6.4, 1.6.6 and 1.6.7
Definitions of terms used in this quality statement
Suspected miscarriage
Women, trans men and non-binary people with bleeding or other symptoms and signs of early pregnancy complications who have:
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pain or
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a pregnancy of 6 weeks' gestation or more or
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a pregnancy of uncertain gestation.
[NICE's guideline on ectopic pregnancy and miscarriage, recommendation 1.4.9 and expert opinion]
Second assessment
Performing a repeat transvaginal ultrasound scan at a minimum of 7 days after the initial scan to confirm diagnosis, and/or seeking a second opinion on the viability of the pregnancy. [NICE's guideline on ectopic pregnancy and miscarriage, recommendations 1.6.3, 1.6.4, 1.6.6 and 1.6.7]
Equality and diversity considerations
When offering a repeat transvaginal ultrasound scan, healthcare professionals should provide information about the scan that is sensitive to the person's religious, ethnic or cultural needs and takes into account whether they have learning disabilities, or difficulties in communication or reading.
If the person does not wish to undergo a transvaginal ultrasound scan, healthcare professionals should offer a transabdominal ultrasound scan and explain the limitations of this method.
There should be an option to be examined by a female member of staff if requested. This may be particularly important for people from certain cultural or religious groups.