The Management of Miscarriage. Max Brinsmead PhD FRANZCOG March 2013. Resources. RCOG Greentop Guidelines “The Management of Early Pregnancy Loss” October 2006 Updated September 2011 MWB Guidelines for the conduct of an Early Pregnancy Assessment Service 2006. Preamble.
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Max Brinsmead PhD FRANZCOG
A systematic approach to assessment
Close follow up
Timely intervention when indicated or requested
In many hospitals this is provided by an “Early Pregnancy Assessment Unit”
When a patient is thought to be pregnant then the doctor or nurse arranges a quantified beta HCG and an ultrasound scan
No history, no exam just tests!
But there is no substitute for a careful history
Because it is essential for the interpretation of some ultrasound findings
So please don’t just rely on the radiologist’s report!
Surgical evacuation of the uterus
Medical evacuation of the uterus
Wait and see
Repeat clinical and USS evaluation after 3 days
Then 7 days and weekly
Must telephone or come in at any hour if pain or bleeding is unacceptable or fever occurs
Several weeks of follow up may be required
20 - 50% of patients request or require curette
Some resorb the trophoblastic tissue with little or no bleeding
Others bleed for weeks