Intended for healthcare professionals


Diagnosing a miscarriage

BMJ 2015; 351 doi: (Published 23 September 2015) Cite this as: BMJ 2015;351:h4769
  1. Elizabeth Anne McCarthy, senior lecturer,
  2. Stephen Tong, professor
  1. 1University of Melbourne, Department of Obstetrics and Gynaecology at Mercy Hospital for Women, Heidelberg, Victoria, Australia
  1. Correspondence to: E A McCarthy eamcca{at}

When is it safe to make the call?

The diagnosis of a miscarriage will more than likely dash the hopes and dreams of couples anticipating the life changing possibilities of a new addition to their family—a new house, extended leave from work, relief in finally appeasing grandparents-in-waiting. It is therefore paramount that clinicians get it right. Always.

It was a touch unnerving when evidence emerged around 2011 suggesting that ultrasonography criteria advocated by official bodies may be too liberal, and that they risked some viable pregnancies being misdiagnosed as miscarriages.1 2 3 4 In response, more conservative ultrasonography criteria were published as recently as 2013.5

Given these recent shifts in criteria to define something so important, it is timely that in this issue Preisler and colleagues (doi:10.1136/bmj.h4579) present a large prospective multicentre study to inform about when it is safe to make the call that a pregnancy has failed.6

Over two and a half years the team recruited 2558 women across seven early pregnancy units in the United Kingdom.6 They included women in whom it was unclear at the first ultrasound scan …

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