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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