09 September 2014
Prompt diagnosis of ectopic pregnancy and miscarriage vital to good care, says NICE
A new quality standard from NICE aims to improve the care of women experiencing a miscarriage or ectopic pregnancy in early pregnancy and could potentially help to save lives.
Women who are referred to early pregnancy assessment services with a suspected ectopic pregnancy or miscarriage should be seen by that service within at least 24 hours, healthcare professionals are being advised.
However, the National Institute for Health and Care Excellence (NICE) is also reminding the NHS that some women may need to be referred directly to their local A&E department as an emergency depending on their symptoms[1].
Its new quality standard says that appropriate referrals, timely investigations and early diagnosis will help to improve care and could potentially save lives.
Hundreds of thousands of babies are born in England and Wales every year - nearly three-quarters of a million were delivered in 2012[2]. Most pregnancies progress successfully, but as many as 1 in 5 will end in miscarriage during the first trimester.
Ectopic pregnancy occurs when the embryo implants outside the womb, often in the fallopian tube. It is relatively uncommon - figures suggest it happens in roughly 11 per 1,000 pregnancies. Symptoms include pain and/or bleeding, or are non-specific and therefore difficult to spot. These pregnancies are never viable.
If ectopic pregnancies go undiagnosed, the fallopian tube can burst causing serious complications. If untreated, ectopic pregnancies can be fatal. Between 2006 and 2008, more than 35,000 women were diagnosed with an ectopic pregnancy - 6 of them died. Four of these deaths may have been associated with inadequate care[3].
Professor Gillian Leng, Deputy Chief Executive and director of health and social care at NICE, said: “To think that you might be losing your baby, either through miscarriage or ectopic pregnancy, is terrifying. It can have a significant impact on the health and wellbeing of the woman and her family.
“It’s important that these women are seen as soon as possible – a long delay could have a potentially devastating effect. It’s something we originally recommended in 2012 and have identified as a key area still in need of improvement.”
The new quality standard also says that women referred to an early pregnancy assessment service with a suspected ectopic pregnancy or miscarriage should be given a transvaginal ultrasound scan to look for any problems. This type of ultrasound scan provides the best quality imaging.
It also advises doctors and nurses that a second assessment should be offered to women with a suspected miscarriage before a diagnosis is confirmed and appropriate treatment is offered.
Belinda Phipps, NCT Chief Executive said: “We welcome this new standard which stresses the importance of women in this situation being seen as quickly as possible. Signs of ectopic pregnancy, especially, may be hard to spot, but can require emergency attention very rapidly.”
The quality standard comes after NICE published wide-ranging guidance on this issue in 2012. The standard picks out 3 key areas identified as priority areas for improvement. Both documents aim to help the NHS provide consistent and effective care to women with either a suspected or diagnosed ectopic pregnancy or miscarriage.
Belinda Phipps added: “The enhanced guidance will improve the physical care offered to women who suffer an unwanted loss of a pregnancy. It is also crucial to remember that the woman and her partner will need emotional support – both now and for future pregnancies.”
Ends
For more information call the NICE press office on 0300 323 0142 or out of hours on 07775 583 813.
Notes to Editors
Explanation of terms
- A woman should be referred directly to an accident and emergency department if she has a suspected ectopic pregnancy or miscarriage and other symptoms that might suggest the condition is serious such as being haemodynamically unstable (having low blood pressure).
- According to the most recent figures from the Office of National Statistics (ONS), 729,000 babies were born in England and Wales during 2012.
- All statistics relating to incidence rates of ectopic pregnancy and deaths have been taken from the following report - Saving Mothers' Lives: Reviewing Maternal Deaths to Make Motherhood Safer 2006-2008: The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom; Centre for Maternal and Child Enquiries (CMACE); March 2011 http://www.hqip.org.uk/assets/NCAPOP-Library/CMACE-Reports/6.-March-2011-Saving-Mothers-Lives-reviewing-maternal-deaths-to-make-motherhood-safer-2006-2008.pdf
About the guidance
The quality standard comprises 3 statements that identify areas in most need of improvement to ensure women receive high-quality care. These statements say:
a. Women referred to early pregnancy assessment services are seen by the service at least within 24 hours of referral.
b. 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.
c. Women with a suspected miscarriage who have had an initial transvaginal ultrasound scan are offered a second assessment to confirm the diagnosis
About NICE
The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.
Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.
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