Advice for women following an early pregnancy scan

Maternity services

You have come for a scan today and depending on the results you will be given advice on your follow-up care.

Inconclusive scan

If the outcome of your scan is uncertain because the pregnancy is not big enough to see a baby with a heartbeat this is called an inconclusive scan.

• You will need a rescan in 14 days’ time to decide the outcome of the pregnancy.
• You may have continuous bleeding during this time.

There are four possible outcomes to your repeat scan:

1. A healthy on-going pregnancy – you will be referred to your community midwife.
2. No growth from the previous scan – a missed miscarriage.
3. If you have bled like a period, you may have an empty womb – a complete miscarriage.
4. If the pregnancy sac is empty an ectopic pregnancy, a pregnancy that grows outside the womb.

If you have symptoms of a miscarriage before your next scan, heavy bleeding and pain which then settles you may not need to attend for the repeat scan. In this case please call the advice line for further advice.

Missed miscarriage

Following a diagnosis of a missed or incomplete miscarriage there are three options that will be discussed with you. A missed miscarriage is a pregnancy that has ended but remains within the womb, an incomplete miscarriage means there is some pregnancy tissue remaining in the womb.

Expectant or natural miscarriage

In most cases a miscarriage will occur naturally if you choose this option: –

• You will be allowed to go home.
• If you have pain and bleeding which then settles, you should do a pregnancy test three weeks after this.
• If the test is negative your miscarriage is complete and you will require no further medical follow-up.
• If the test is positive, you should contact ward 19 or the Friarage for advice.
• If you have no pain or bleeding in the next two weeks contact ward 19 or the Friarage for a further plan of care.
• We offer a follow-up phone call three weeks after your miscarriage, if you would like this let us know.

Medical management of miscarriage at home

If you are under 12 weeks pregnant and you would prefer your treatment at home, we recommend that you have an adult with you at all times.

• In hospital you will be given one Mifepristone tablet, this will prepare your body to miscarry.
• Two days (48 hours) later at home you will take four Misoprostal tablets with water, swallow directly do not chew.
• You will have heavy period type bleeding and cramping and as you are about to miscarry the bleeding will become heavier and you will pass some clots.
• Take your pain relief (paracetamol and codeine) and anti-diarrhoea tablets (loperamide) as required.

• If after two days the bleeding has not started you will need to take two more misoprostol tablets.
• Once you have miscarried the pain and heavy bleeding will settle but you may go on to bleed for up to 14 days.
• If you think you have had a miscarriage you need to perform a pregnancy test three weeks following the date of the miscarriage. If the result is negative the miscarriage is complete. If the test is still positive you will need to contact ward 19 for follow-up.
• If you have not miscarried after taking the full course of tablets you will need to contact ward 19 for a further plan of care.

• After your miscarriage if you would prefer to bring your pregnancy into the hospital we can arrange for cremation. If you would like details of this, please ask your midwife.
• We offer a follow-up phone call three weeks after your miscarriage, if you would like this let us know

Medical management of miscarriage in hospital

If this is your preferred choice or you are more than 12 weeks pregnant:

• In hospital you will be given one Mifepristone tablet, this will prepare your body to miscarry.
• Two days (48 hours) later you will attend ward 19 at a time and date agreed with you.
• You will be made comfortable in a single room and you can bring someone with you.
• We will give you four Misoprostal tablets to take with water, swallow directly do not chew.
• You will have heavy period type bleeding and cramping and as you are about to miscarry the bleeding will become heavier and you will pass some clots.
• We will give you pain relief (paracetamol and codeine) and anti-diarrhoea tablets (loperamide) as required.
• If after 4 hours you have not miscarried you will need to take two more misoprostol tablets.
• Once you have miscarried the pain and heavy bleeding will settle and you can go home but you may go on to bleed for up to 14 days.
• You will be advised to perform a pregnancy test three weeks following the date of the miscarriage. If the result is negative the miscarriage is complete. If the test is still positive you will need to contact ward 19 for follow-up.
• If you have not miscarried after taking the full course of tablets a further plan of care will be discussed with you.

• All babies are handled in a sensitive manner in partnership with our local crematorium, if you would like details of this please ask your midwife. Alternatively you may want to make your own arrangements.
• We offer a follow-up phone call three weeks after your miscarriage, if you would like this let us know.

Complete miscarriage

You have given a history of miscarriage and you have an empty womb.

• You will be advised to perform a pregnancy test three weeks following the date of the miscarriage. If the result is negative the miscarriage is complete. If the test is still positive you will need to contact ward 19 for follow-up.

How to access psychological support

There are a range of services that can provide you with psychological support following your miscarriage.

Talking services
Improving Access to Psychological Therapies IAPTS
Impact Teesside
Tel: 01642 573924
www.impactonteesside.com

Friarage area, Tel: 01609 768891

The Miscarriage Association
www.themiscarriageassociation.org

Patient experience

South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.

This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.

To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.

T: 01642 835964
E: [email protected]

The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW.
Telephone: 01642 850850

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