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Practice Guidelines

Ectopic pregnancy and miscarriage: diagnosis and initial management: summary of updated NICE guidance

BMJ 2019; 367 doi: (Published 13 November 2019) Cite this as: BMJ 2019;367:l6283
  1. Katie Webster, senior systematic reviewer1,
  2. Hilary Eadon, guideline lead1,
  3. Sarah Fishburn, chair of Guideline Committee1,
  4. Geeta Kumar, consultant obstetrician and gynaecologist and topic lead2
  5. on behalf of the Guideline Committee
  1. 1National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London NW1 4RG, UK
  2. 2Wrexham Maelor Hospital, Wrexham LL13 7TD, UK
  1. Correspondence to: G Kumar geeta.kumar{at}

What you need to know

  • The guideline now includes new recommendations on the ultrasound features for diagnosis of a tubal ectopic pregnancy

  • Women without pain who have small ectopic pregnancies, low serum human chorionic gonadotropin (hCG) levels, and are able to return for follow-up may be offered the option of expectant management of ectopic pregnancy

  • Women choosing expectant management for a diagnosed tubal ectopic pregnancy require close follow-up with immediate referral to secondary care if their condition deteriorates

  • When diagnosing complete miscarriage on an ultrasound scan, in the absence of a previous scan confirming an intrauterine pregnancy, always be aware of the possibility of a pregnancy of unknown location. Advise these women to return for follow-up (for example, measurement of hCG levels, ultrasound scans) until a definitive diagnosis is obtained

Miscarriage and ectopic pregnancy have an adverse effect on the quality of life of many women, with early pregnancy loss accounting for over 50 000 hospital admissions in the UK annually.1 Ectopic pregnancy (where the pregnancy implants outside the endometrial cavity, most commonly within the fallopian tube) occurs in approximately 11 per 1000 pregnancies.2 Unfortunately, women still die during early pregnancy, with four maternal deaths reported in the UK between 2013 and 2015.3 However, the case fatality rate has decreased over recent years,2 suggesting that earlier diagnosis and treatment has made an impact. Accurate diagnosis and effective management of early pregnancy loss is therefore vital to avoid women dying unnecessarily, and to reduce the incidence of associated physical and psychological morbidity.

This article summarises the updated recommendations from the National Institute for Health and Care Excellence (NICE) on the diagnosis and management of tubal ectopic pregnancy and miscarriage in early pregnancy (up to 13 completed weeks of pregnancy).4

In addition to these updated recommendations, the guideline also contains recommendations on providing …

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