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Ectopic pregnancy and miscarriage overview

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Ectopic pregnancy and miscarriage HAI

About

What is covered

This pathway covers the diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage.
Ectopic pregnancy and miscarriage have an adverse effect on the quality of life of many women. Approximately 20% of pregnancies miscarry, and miscarriages can cause considerable distress. Early pregnancy loss accounts for over 50,000 admissions in the UK annually. The rate of ectopic pregnancy is 11 per 1000 pregnancies, with a maternal mortality of 0.2 per 1000 estimated ectopic pregnancies. About two thirds of these deaths are associated with substandard care. Women who do not access medical help readily (such as women who are recent migrants, asylum seekers, refugees, or women who have difficulty reading or speaking English) are particularly vulnerable. Improvement in the diagnosis and management of early pregnancy loss is thus of vital importance, in order to reduce the incidence of the associated psychological morbidity and avoid the unnecessary deaths of women with ectopic pregnancies.

Updates

Updates to this pathway

26 August 2014 Minor maintenance updates.
17 December 2013 Minor maintenance updates.
19 April 2013 Minor maintenance updates.

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Short Text

Diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage.

What is covered

This pathway covers the diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage.
Ectopic pregnancy and miscarriage have an adverse effect on the quality of life of many women. Approximately 20% of pregnancies miscarry, and miscarriages can cause considerable distress. Early pregnancy loss accounts for over 50,000 admissions in the UK annually. The rate of ectopic pregnancy is 11 per 1000 pregnancies, with a maternal mortality of 0.2 per 1000 estimated ectopic pregnancies. About two thirds of these deaths are associated with substandard care. Women who do not access medical help readily (such as women who are recent migrants, asylum seekers, refugees, or women who have difficulty reading or speaking English) are particularly vulnerable. Improvement in the diagnosis and management of early pregnancy loss is thus of vital importance, in order to reduce the incidence of the associated psychological morbidity and avoid the unnecessary deaths of women with ectopic pregnancies.

Updates

Updates to this pathway

26 August 2014 Minor maintenance updates.
17 December 2013 Minor maintenance updates.
19 April 2013 Minor maintenance updates.

Sources

NICE guidance

The NICE guidance that was used to create the pathway.
Ectopic pregnancy and miscarriage. NICE clinical guideline 154 (2012)

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Commissioning

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.

Education and learning

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Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Pathway information

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Supporting information

Symptoms and signs of ectopic pregnancy

Symptoms of ectopic pregnancy include:
  • common symptoms:
    • abdominal or pelvic pain
    • amenorrhoea or missed period
    • vaginal bleeding with or without clots.
  • other reported symptoms:
    • breast tenderness
    • gastrointestinal symptoms
    • dizziness, fainting or syncope
    • shoulder tip pain
    • urinary symptoms
    • passage of tissue
    • rectal pressure or pain on defecation.
Signs of ectopic pregnancy include:
  • more common signs:
    • pelvic tenderness
    • adnexal tenderness
    • abdominal tenderness
  • other reported signs:
    • cervical motion tenderness
    • rebound tenderness or peritoneal signs
    • pallor
    • abdominal distension
    • enlarged uterus
    • tachycardia (more than 100 beats per minute) or hypotension (less than 100/60 mmHg)
    • shock or collapse
    • orthostatic hypotension.
Offer anti-D rhesus prophylaxis at a dose of 250 IU (50 micrograms) to all rhesus negative women who have a surgical procedure to manage an ectopic pregnancy or a miscarriage.

Glossary

Accident and emergency.
Immunoglobulin that binds to, and causes the removal of, any Rhesus D positive red blood cells that have passed from the fetus into the maternal circulation.
Pregnancy in the first trimester – that is, up to 13 completed weeks of pregnancy.
A service for women with early pregnancy complications, where scanning can be carried out and decisions about management made. For example, it could be an early pregnancy assessment unit or specialist gynaecology service.
A pregnancy located outside of the uterine cavity, usually in the fallopian tube.
A management approach in which a patient is closely monitored (for example, with observations, scans or blood tests) but treatment is not administered, with the aim of seeing whether the condition will resolve naturally.
Human chorionic gonadotrophin.
A descriptive term used to classify a pregnancy when a woman has a positive pregnancy test but no pregnancy can be seen on ultrasound scan.
Surgical removal of the fallopian tube.
Surgical incision of a fallopian tube to remove an ectopic pregnancy.

Paths in this pathway

Pathway created: December 2012 Last updated: August 2014

© NICE 2014

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