Download Management of the stable intrauterine non

Department of Health
Queensland Clinical Guidelines
Management of the stable intrauterine non-viable pregnancy
Care provision
• Access to emergency care is required
• Provide written information on what to expect and indications
for return to hospital
Follow-up
• Arrange follow-up within 7-10 days
• If symptomatic or evidence of retained POC, discuss options
for continued expectant or medical or surgical care
Indications
• Offer to women who prefer this option
Contraindications
• Suspected or confirmed ectopic pregnancy
• Gestational Trophoblastic Disease
• Intrauterine device insitu
• Allergy to prostaglandins
• Medical contraindications
Regimen
• Misoprostol is the drug of choice
• Requires specific patient consent (not TGA approved)
• May be offered as outpatient or day procedure
• Inform women that bleeding may continue for up to 3 weeks
Dose
• Day 1: 800 micrograms PV
• Day 2: 800 micrograms PV – unless complete miscarriage
confirmed
• Day 8: If expulsion incomplete – consider suction curettage
Surgical
Follow-up
• If POC not passed within 48 hours consider surgical
management
• Review in 48 hours and on day 8
• Perform FBC, β-hCG, and USS
• Medical review 6 weeks after first dose
Indications
• Offer to women who prefer this option
• Haemodynamically unstable
• Persistent excessive bleeding
• Evidence of infected retained tissue
• Suspected Gestational Trophoblastic Disease
• Unsuccessful expectant or medical management
Care provision
• Suction curettage is recommended
• Consider cervical priming with Misoprostol
• Consider screening for vaginal infections
• Routine use of antibiotics not required
Follow-up
• Follow-up with GP, EPAS or equivalent
Queensland Clinical Guideline: MN11.29-V3-R16 Early pregnancy loss
Document Number: F15.29-3-V3-R16
Care provision
• Discuss all options for care
• Offer access to support
services for psychological care
• Offer analgesia as required
• Consider requirement for Anti-D
• Provide written information
regarding follow-up
• Communicate information to
other relevant care providers
(e.g. GP)
Medical
Clinical presentation
• Haemodynamically stable
• Non-viable intrauterine
pregnancy
State of Queensland (Queensland Health) 2015
http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en Queensland Clinical Guidelines, [email protected]
Expectant
Indications
• Offer to women who prefer this option