He said: “Some women are already advised to wait up to 14 days after the first scan to confirm the diagnosis of miscarriage, particularly if there are doubts about gestational age. If a miscarriage is diagnosed, there are three options: to wait for nature to take its course, surgery, or to take pills that will precipitate the expulsion of the foetus.ĭr Paul Fogarty, a consultant obstetrician and vice-president of the Royal College of Obstetricians and Gynaecologists, said the Nice guidelines had been carefully drafted to avoid misdiagnosis. But “most people would want absolute certainty”. Uncertainty is a terrible thing for people to have,” he said. Parents would inevitably be anxious and afraid while waiting for the second scan. If you do that, then the chance of a false positive is just not there – it’s zero per cent.” What we are saying is, in most cases, you simply wait a little bit longer, perhaps 14 days. We are talking about a small number of cases, but remember there should be no errors over something as important as this. “Our data says that if you do that, you are possibly going to have a false positive diagnosis in a small number of cases. Most guidelines say if you’re uncertain, then come back in seven days, repeat the scan, and at that time you should expect to see a heartbeat or, perhaps if you have an empty sac, you should expect to see an embryo. We have shown that perhaps people are being brought back too early. “Just one misdiagnosis of miscarriage is too many. It’s an area of medicine where the highest levels of caution are warranted,” said Bourne. “Women should be able to rely on a diagnosis of miscarriage. Photograph: Media for Medical/UIG via Getty Images Ultrasound scan of a 30-year-old woman in her second month of pregnancy. Broadly, the guidelines were now right, the team said, but they are not specific enough about the size of the embryo related to gestational age and should specify the 14-day wait between scans in most cases. In 2011, as a result of work by the same team of experts, it was recognised that the guidelines that had existed were unsafe and that there was a risk that some viable pregnancies might have been ended. It rests on the size of any embryo, if it can be seen, the size of the gestational sac and whether it appears empty, and whether a heartbeat can be detected during an ultrasound scan. But establishing whether a miscarriage has taken place in the early weeks is difficult. About one in five pregnancies ends in miscarriage, most within the first three months. The early weeks of pregnancy are an anxious time for women. “When they are dealing with something as important as miscarriage, it has to be black and white,” he said. But the guidelines need to state that this must happen, said Tom Bourne, consultant gynaecologist at Queen Charlotte’s and Chelsea hospital, professor at Imperial College, and the lead author of the study. Many doctors will offer a second scan even for a smaller pregnancy. The guidelines from the National Institute for Health and Care Excellence (Nice) say that a second scan should be offered if the gestational sac is over 25mm in diameter. The researchers found that 19 pregnancies out of 549 would have wrongly been thought to have miscarried if the current guidelines had been followed and they had not been scanned two weeks later. A large study published in the BMJ Open journal looked at the outcomes for 2,845 women who arrived at NHS hospitals with bleeding or pain and had a scan that doctors felt showed the continuation of the pregnancy was uncertain.
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