Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Criteria for referral to a specialist for a patient with miscarriage include:
- Presence of pain and/or bleeding in early pregnancy that requires assessment by a healthcare professional before referral to an early pregnancy assessment service (specialist) NICE NG126.
- Clinical instability or significant symptoms such as heavy bleeding, pelvic pain, or fever after miscarriage, especially if symptoms worsen or new symptoms develop NICE NG126.
- Positive pregnancy test after 3 weeks post-miscarriage requiring review to rule out retained products, molar or ectopic pregnancy, or need for further treatment NICE NG126.
- Women with recurrent miscarriage or previous ectopic or molar pregnancy may self-refer directly to early pregnancy assessment services NICE NG126.
- Need for ultrasound and serum hCG assessment to confirm diagnosis and guide management, which is typically available in specialist early pregnancy assessment services NICE NG126.
- Women who are clinically unstable, have significant pain, or do not meet criteria for expectant management should be referred for specialist assessment NICE NG126.
Referral should ensure access to a specialist early pregnancy assessment service that operates 7 days a week and can provide timely ultrasound and hCG testing, with staff trained in sensitive communication NICE NG126.