This is an updated guideline on ectopic pregnancy and miscarriage from Nice (published Nov 2021). It was last updated in 2019.
The 2021 update gives guidance on the use of progesterone in women with a threatened miscarriage. There is good evidence that using vaginal progesterone in a woman with a threatened miscarriage, who has had a previous miscarriage, increases the likelihood of a live birth.
Useful bits of information
- Expectant Management – see below – this is good for us to know.
- Presentation of Ectopic Pregnancy. Remember that presentation can be nebulous.
- Pregnancy Tests. All surgeries should have pregnancy tests available (at the moment I would suggest that only a minority have them – should we think about carrying them?).
- Emergency Contact Numbers. Ensure women know who to contact if symptoms worsen.
Refer immediately patients who have a positive pregnancy test AND:
- Abdo pain AND tenderness OR
- Pelvic tenderness OR
- Cervical Motion tenderness