•All cases of miscarriage diagnosed in St Helier Hospital EPU during the study period were assessed for compliance with national guidance parameters for ultrasound diagnosis.

•The waiting time for surgical management of miscarriage (SMM) or manual vacuum aspiration (MVA), including the number of unintended miscarriages whilst awaiting treatment was also assessed.

•15.3% (n=22) had a single, transabdominal scan with 2 operators, but without a two-weekly follow-up scan to confirm the diagnosis

•4.2% (n=6) either lacked confirmation from a second operator at the time of a TVUS or reported the diagnosis based on abnormal sac size/location

Of the 88 patients who had not completed miscarriage, 12% opted for MVA and 34% for SMM with mean waits of 3.6 days and 2.0 days, respectively. An unintended 9.8% of patients completed their miscarriage physiologically whilst awaiting surgical treatment.

No patients undergoing either MVA or SMM required further management. In contrast, 43% of patients who opted for expectant, and 46% of patients who opted for medical management required further treatment.

 

Conclusion

A minimum of 14 days is required between transabdominal ultrasound scans when confirming the diagnosis of miscarriage in early pregnancy, however there is a lack of clarity for those cases identified at the time of nuchal scan. When counselling women regarding treatment options for miscarriage, NICE recommends that expectant management is offered first-line, as ‘most women do not require further treatment’. This is in direct contrast to this study’s findings however; therefore care must be taken when counselling women who opt for expectant management, with regards to the likelihood of an unsuccessful outcome.