Guideline No. 460: Diagnosis and Management of Intrauterine Early Pregnancy Loss.

OBJECTIVE

To provide an evidence-based approach to guide the diagnosis and management of intrauterine early pregnancy loss.

TARGET POPULATION: This population includes patients experiencing pregnancy loss/miscarriage and incomplete pregnancy loss in the context of a normally sited intrauterine pregnancy. It does not include patients with a pregnancy of unknown location, ectopic pregnancy or recurrent pregnancy loss (2 or more pregnancy losses).

BENEFITS, HARMS, AND COSTS: Incorrect diagnosis of a pregnancy loss increases the risk of harming a live, normally sited pregnancy. Prolonged waiting for confirmation of a diagnosis can increase anxiety and delay treatment. Patient-centred care discussions can help patients understand their pregnancy loss risk and make decisions about their management and follow-up, including time off for bereavement and mental health support.

EVIDENCE: The following search terms were entered into PubMed from January 2021 to December 2024: early pregnancy loss, incomplete, spontaneous abortion, diagnosis, and management. The International Society of Ultrasound in Obstetrics and Gynecology (2021 and 2022), and Association of Early Pregnancy Units presentations and references were also used.

VALIDATION

METHODS

The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations).

INTENDED AUDIENCE: Health care providers who provide care to pregnant patients experiencing intrauterine early pregnancy loss.

TWEETABLE ABSTRACT: Early pregnancy loss is a common experience that can be traumatic. Patient-centred care in an Early Pregnancy Assessment Clinic can help patients make informed decisions.

SUMMARY STATEMENTS: RECOMMENDATIONS.