Guidelines

Ectopic pregnancy and miscarriage: summary of NICE guidance

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8136 (Published 12 December 2012)
Cite this as: BMJ 2012;345:e8136

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  1. Emma Newbatt, research associate1,
  2. Zosia Beckles, information scientist1,
  3. Roz Ullman, senior research fellow and clinical lead (midwifery)1,
  4. Mary Ann Lumsden, professor of gynaecology and medical education and honorary consultant gynaecologist2
  5. on behalf of the Guideline Development Group
  1. 1National Collaborating Centre for Women’s and Children’s Health, London W1T 2QA, UK
  2. 2University of Glasgow, Glasgow G4 0SF, UK
  1. Correspondence to: R Ullman rullman{at}ncc-wch.org.uk

Many women will experience complications in early pregnancy. The loss of a pregnancy can cause considerable emotional distress for women and their families, as well as physical morbidity that results in over 50 000 inpatient admissions in the UK annually.1 The mortality associated with ectopic pregnancy is decreasing but remains at an estimated 0.2 per 1000 ectopic pregnancies. Of the women who died during 2006–08, half were from minority ethnic groups—and so may have accessed care later or experienced difficulty in communication—and most deaths were associated with substandard care due to failure to consider ectopic pregnancy when presentation was atypical.2 Therefore, it is vital that healthcare professionals in all specialties are alert to the possibility of ectopic pregnancy in order to avoid missed opportunities for diagnosis. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the care for women with ectopic pregnancy and miscarriage.3

Recommendations

NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italics in square brackets.

Support and information giving

  • Throughout a woman’s care, give her and (with agreement) her partner, specific evidence based information in a variety of formats. This should include (as appropriate):

    • -When and how to seek help if existing symptoms worsen or new symptoms develop, including a 24 hour contact telephone number.

    • -What to expect during the time she is waiting for an ultrasound scan (for example, whether new symptoms might develop and what these are likely to be).

    • -What to expect during the course of her care (including expectant management), such as the potential length and extent of pain …

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