ULTRASOUND


Woman with a confirmed diagnosis of miscarriage


Giving information


Expectant management


Explore options other than expectant management if appropriate


Bleeding and pain have not started or are persistent and/or increasing


Resolution of bleeding and pain


Continued expectant management


Surgical management of miscarriage


Medical management of incomplete or missed miscarriage


 Figure 4: Management of Miscarriage. National Institute for Health and Care Excellence (2015).


only being used as an alternative to expectant and medical management. This is most likely due to the need for anaesthetic and high number of admissions7 Additionally, the study by Trinder et al23


found that


there was a higher number of patients diagnosed with infection following surgical management compared with medical management.


OTHER IMAGING


Ultrasound is the main method of imaging for obstetrics, as it provides accurate information with no known risk to the fetus or the mother30


. Nevertheless,


in some cases, other modalities or methods may be used to image the fetus. When using ionising radiation to image the fetus, the potential risks to the fetus in relation to radiation, high magnetic fields, noise and contrast agents must be considered and assessed carefully against the clinical urgency31


. For example,


there has been no documentation of magnetic resonance imaging (MRI) causing any damage to the developing fetus31


. However, there still should be an


assessment made in relation to the necessity of the imaging and to the fetus, due to the unknown risk of MRI32


. Colour Doppler ultrasound, as observed by the 22


.


author, can be utilised to confirm the presence or absence of blood flow within retained products of conception, which can also predict the rate of success for expectant management26 the study by Wang et al33


coincide with this and


state that the detectability rate of endometrial blood flow was 94.5%. However, the study conducted by Bottomley and Bourne13


states that in early pregnancy,


studies show that there is no significant difference in vascular indices between miscarriages and successful pregnancies. Therefore, this study states that it is of limited use in the diagnosis of miscarriage and should be avoided in first trimester cases, due to the potential risk of damage to the developing fetus from tissue-heating. Three dimensional (3D) ultrasound, is also considered as an alternative method of imaging the fetus, as it provides a 3D assessment of the gestational sac which, in the first trimester, can be used as a sensitive indicator for pregnancy outcome3


.


However, the study by Jauniaux, Johns and Burton3 also states that although it has been proven useful for determining the outcome of expectant management, it appears to add little to the diagnostic or prognostic value of traditional two dimensional ultrasound.


JUNE 2017


. The results of


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