People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care.
NICE guidelines set out the care and services suitable for people with a specific condition or need, and people in particular circumstances or settings. We aim to improve quality by ensuring that people receive the best care and advice. Using inclusive language in healthcare is important for safety, and to promote equity, respect and effective communication with everyone. This guideline does not use inclusive language in whole or in part because:
the evidence has not been reviewed, and it is not certain from expert opinion which groups the advice covers, or
the evidence has been reviewed, but the information available for some groups was too limited to make specific recommendations, or
only a very limited number of recommendations have been updated in direct response to new evidence or to reflect a change in practice.
Healthcare professionals should use their clinical judgement when implementing recommendations, taking into account the individual's circumstances, needs and preferences, and ensuring all people are treated with dignity and respect throughout their care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.
Treat all women with early pregnancy complications with dignity and respect. Be aware that women will react to complications or the loss of a pregnancy in different ways. Provide all women with information and support in a sensitive manner, taking into account their individual circumstances and emotional response. For more guidance about providing information, see the NICE guideline on patient experience in adult NHS services. [2012]
Healthcare professionals providing care for women with early pregnancy complications in any setting should be aware that early pregnancy complications can cause significant distress for some women and their partners. Healthcare professionals providing care for these women should be given training in how to communicate sensitively and breaking bad news. Non-clinical staff such as receptionists working in settings where early pregnancy care is provided should also be given training on how to communicate sensitively with women who experience early pregnancy complications. For more guidance about support, see recommendation 1.9.4 on traumatic birth, stillbirth and miscarriage in the NICE guideline on antenatal and postnatal mental health. [2012, amended 2019]
Throughout a woman's care, provide the woman and (with her consent) her partner specific evidence-based information in a variety of formats. This should include (as appropriate):
when and how to seek help if existing symptoms worsen or new symptoms develop, including a 24‑hour contact telephone number
what to expect during the time she is waiting for an ultrasound scan
what to expect during the course of her care (including expectant management), such as the potential length and extent of pain and/or bleeding, and possible side effects; this information should be tailored to the care she receives
information about postoperative care (for women undergoing surgery)
what to expect during the recovery period – for example, when it is possible to resume sexual activity and/or try to conceive again, and what to do if she becomes pregnant again; this information should be tailored to the care she receives
information about the likely impact of her treatment on future fertility
where to access support and counselling services, including leaflets, web addresses and helpline numbers for support organisations.
Ensure that sufficient time is available to discuss these issues with women during the course of her care and arrange an additional appointment if more time is needed. [2012]
After an early pregnancy loss, offer the woman the option of a follow‑up appointment with a healthcare professional of her choice. [2012]
Regional services should be organised so that an early pregnancy assessment service is available 7 days a week for women with early pregnancy complications, where scanning can be carried out and decisions about management made. [2012]
An early pregnancy assessment service should:
be a dedicated service provided by healthcare professionals competent to diagnose and care for women with pain and/or bleeding in early pregnancy and
offer ultrasound and assessment of serum human chorionic gonadotrophin (hCG) levels and
be staffed by healthcare professionals with training in sensitive communication and breaking bad news. [2012]
Early pregnancy assessment services should accept self-referrals from women who have had recurrent miscarriage or a previous ectopic or molar pregnancy. Although additional care for women with recurrent miscarriage is not included in the scope of the guideline, the Guideline Development Group recognised that it is common clinical practice to allow these women to self-refer to an early pregnancy assessment service and wished this to remain the case. All other women with pain and/or bleeding should be assessed by a healthcare professional (such as a GP, accident and emergency [A&E] doctor, midwife or nurse) before referral to an early pregnancy assessment service. [2012]
Ensure that a system is in place to enable women referred to their local early pregnancy assessment service to attend within 24 hours if the clinical situation warrants this. If the service is not available, and the clinical symptoms warrant further assessment, refer women to the nearest accessible facility that offers specialist clinical assessment and ultrasound scanning (such as a gynaecology ward or A&E service with access to specialist gynaecology support). [2012]
Refer women who are haemodynamically unstable, or in whom there is significant concern about the degree of pain or bleeding, directly to A&E. [2012]
Be aware that atypical presentation for ectopic pregnancy is common. [2012]
Be aware that ectopic pregnancy can present with a variety of symptoms. Even if a symptom is less common, it may still be significant. Symptoms of ectopic pregnancy include:
common symptoms:
abdominal or pelvic pain
amenorrhoea or missed period
vaginal bleeding with or without clots
other reported symptoms:
breast tenderness
gastrointestinal symptoms
dizziness, fainting or syncope
shoulder tip pain
urinary symptoms
passage of tissue
rectal pressure or pain on defecation. [2012]
Be aware that ectopic pregnancy can present with a variety of signs on examination by a healthcare professional. Signs of ectopic pregnancy include:
more common signs:
pelvic tenderness
adnexal tenderness
abdominal tenderness
other reported signs:
cervical motion tenderness
rebound tenderness or peritoneal signs
pallor
abdominal distension
enlarged uterus
tachycardia (more than 100 beats per minute) or hypotension (less than 100/60 mmHg)
shock or collapse
orthostatic hypotension. [2012]
During clinical assessment of women of reproductive age, be aware that:
they may be pregnant, and think about offering a pregnancy test even when symptoms are non-specific and
the symptoms and signs of ectopic pregnancy can resemble the common symptoms and signs of other conditions – for example, gastrointestinal conditions or urinary tract infection. [2012]
All healthcare professionals involved in the care of women of reproductive age should have access to pregnancy tests. [2012]
Refer immediately to an early pregnancy assessment service (or out-of-hours gynaecology service if the early pregnancy assessment service is not available) for further assessment of women with a positive pregnancy test and the following on examination:
pain and abdominal tenderness or
pelvic tenderness or
cervical motion tenderness. [2012]
Exclude the possibility of ectopic pregnancy, even in the absence of risk factors (such as previous ectopic pregnancy), because about a third of women with an ectopic pregnancy will have no known risk factors. [2012]
Refer to an early pregnancy assessment service (or out-of-hours gynaecology service if the early pregnancy assessment service is not available) women with bleeding or other symptoms and signs of early pregnancy complications who have:
pain or
a pregnancy of 6 weeks' gestation or more or
a pregnancy of uncertain gestation.
The urgency of this referral depends on the clinical situation. [2012]
Use expectant management for women with a pregnancy of less than 6 weeks' gestation who are bleeding but not in pain, and who have no risk factors, such as a previous ectopic pregnancy. Advise these women:
to return if bleeding continues or pain develops
to repeat a urine pregnancy test after 7 to 10 days and to return if it is positive
a negative pregnancy test means that the pregnancy has miscarried. [2012, amended 2019]
Refer women who return with worsening symptoms and signs that could suggest an ectopic pregnancy to an early pregnancy assessment service (or out-of-hours gynaecology service if the early pregnancy assessment service is not available) for further assessment. The decision about whether she should be seen immediately or within 24 hours will depend on the clinical situation. [2012]
If a woman is referred to an early pregnancy assessment service (or out-of-hours gynaecology service if the early pregnancy assessment service is not available), explain the reasons for the referral and what she can expect when she arrives there. [2012]
Offer women who attend an early pregnancy assessment service (or out-of-hours gynaecology service if the early pregnancy assessment service is not available) a transvaginal ultrasound scan to identify the location of the pregnancy and whether there is a fetal pole and heartbeat. [2012]
Consider a transabdominal ultrasound scan for women with an enlarged uterus or other pelvic pathology, such as fibroids or an ovarian cyst. [2012]
If a transvaginal ultrasound scan is unacceptable to the woman, offer a transabdominal ultrasound scan and explain the limitations of this method of scanning. [2012]
Inform women that the diagnosis of miscarriage using 1 ultrasound scan cannot be guaranteed to be 100% accurate and there is a small chance that the diagnosis may be incorrect, particularly at very early gestational ages. [2012]
When performing an ultrasound scan to determine the viability of an intrauterine pregnancy, first look to identify a fetal heartbeat. If there is no visible heartbeat but there is a visible fetal pole, measure the crown–rump length. Only measure the mean gestational sac diameter if the fetal pole is not visible. [2012]
If the crown–rump length is less than 7.0 mm with a transvaginal ultrasound scan and there is no visible heartbeat, perform a second scan a minimum of 7 days after the first before making a diagnosis. Further scans may be needed before a diagnosis can be made. [2012]
If the crown–rump length is 7.0 mm or more with a transvaginal ultrasound scan and there is no visible heartbeat:
seek a second opinion on the viability of the pregnancy and/or
perform a second scan a minimum of 7 days after the first before making a diagnosis. [2012]
If there is no visible heartbeat when the crown–rump length is measured using a transabdominal ultrasound scan:
record the size of the crown–rump length and
perform a second scan a minimum of 14 days after the first before making a diagnosis. [2012]
If the mean gestational sac diameter is less than 25.0 mm with a transvaginal ultrasound scan and there is no visible fetal pole, perform a second scan a minimum of 7 days after the first before making a diagnosis. Further scans may be needed before a diagnosis can be made. [2012]
If the mean gestational sac diameter is 25.0 mm or more using a transvaginal ultrasound scan and there is no visible fetal pole:
seek a second opinion on the viability of the pregnancy and/or
perform a second scan a minimum of 7 days after the first before making a diagnosis. [2012]
If there is no visible fetal pole and the mean gestational sac diameter is measured using a transabdominal ultrasound scan:
record the size of the mean gestational sac diameter and
perform a second scan a minimum of 14 days after the first before making a diagnosis. [2012]
Do not use gestational age from the last menstrual period alone to determine whether a fetal heartbeat should be visible. [2012]
Inform women that the date of their last menstrual period may not give an accurate representation of gestational age because of variability in the menstrual cycle. [2012]
Inform women what to expect while waiting for a repeat scan and that waiting for a repeat scan has no detrimental effects on the outcome of the pregnancy. [2012]
Give women a 24‑hour contact telephone number so that they can speak to someone with experience of caring for women with early pregnancy complications who understands their needs and can advise on appropriate care. See also recommendation 1.1.3 for details of further information that should be provided. [2012]
When diagnosing complete miscarriage on an ultrasound scan, in the absence of a previous scan confirming an intrauterine pregnancy, always be aware of the possibility of a pregnancy of unknown location. Advise these women to return for follow‑up (for example, hCG levels, ultrasound scans) until a definitive diagnosis is obtained. (See also recommendations on human chorionic gonadotrophin measurements in women with pregnancy of unknown location.) [2012, amended 2019]
When carrying out a transvaginal ultrasound scan in early pregnancy, look for these signs indicating there is a tubal ectopic pregnancy:
an adnexal mass, moving separate to the ovary (sometimes called the 'sliding sign'), comprising a gestational sac containing a yolk sac or
an adnexal mass, moving separately to the ovary, comprising a gestational sac and fetal pole (with or without fetal heartbeat). [2019]
When carrying out a transvaginal ultrasound scan in early pregnancy, look for these signs indicating a high probability of a tubal ectopic pregnancy:
an adnexal mass, moving separately to the ovary (sometimes called the 'sliding sign'), with an empty gestational sac (sometimes described as a 'tubal ring' or 'bagel sign') or
a complex, inhomogeneous adnexal mass, moving separate to the ovary.
If these features are present, take into account other intrauterine and adnexal features on the scan, the woman's clinical presentation and serum hCG levels before making a diagnosis. [2019]
When carrying out a transvaginal ultrasound scan in early pregnancy, look for these signs indicating a possible ectopic pregnancy:
an empty uterus or
a collection of fluid within the uterine cavity (sometimes described as a pseudo-sac; this collection of fluid must be differentiated from an early intrauterine sac, which is identified by the presence of an eccentrically located hypoechoic structure with a double decidual sign [gestational sac surrounded by 2 concentric echogenic rings] in the endometrium).
If these features are present, take into account other intrauterine and adnexal features on the scan, the woman's clinical presentation and serum hCG levels before making a diagnosis. (See also recommendations on human chorionic gonadotrophin measurements in women with pregnancy of unknown location.) [2019]
When carrying out a transabdominal or transvaginal ultrasound scan in early pregnancy, look for a moderate to large amount of free fluid in the peritoneal cavity or Pouch of Douglas, which might represent haemoperitoneum. If this is present, take into account other intrauterine and adnexal features on the scan, the woman's clinical presentation and hCG levels before making a diagnosis. [2019]
When carrying out a transabdominal or transvaginal ultrasound scan during early pregnancy, scan the uterus and adnexae to see if there is a heterotopic pregnancy. [2019]
All ultrasound scans should be performed or directly supervised and reviewed by appropriately qualified healthcare professionals with training in, and experience of, diagnosing ectopic pregnancies. [2012, amended 2019]
For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on using ultrasound for diagnosis of a tubal ectopic pregnancy.
Full details of the evidence and the committee's discussion are in evidence review A: diagnostic accuracy of ultrasound features for tubal ectopic pregnancy.
Be aware that women with a pregnancy of unknown location could have an ectopic pregnancy until the location is determined. [2012]
Do not use serum hCG measurements to determine the location of the pregnancy. [2012]
In a woman with a pregnancy of unknown location, place more importance on clinical symptoms than on serum hCG results, and review the woman's condition if any of her symptoms change, regardless of previous results and assessments. [2012]
Use serum hCG measurements only for assessing trophoblastic proliferation to help to determine subsequent management. [2012]
Take 2 serum hCG measurements as near as possible to 48 hours apart (but no earlier) to determine subsequent management of a pregnancy of unknown location. Take further measurements only after review by a senior healthcare professional. [2012]
Regardless of serum hCG levels, give women with a pregnancy of unknown location written information about what to do if they experience any new or worsening symptoms, including details about how to access emergency care 24 hours a day. Advise women to return if there are new symptoms or if existing symptoms worsen. [2012]
For a woman with an increase in serum hCG levels greater than 63% after 48 hours:
Inform her that she is likely to have a developing intrauterine pregnancy (although the possibility of an ectopic pregnancy cannot be excluded).
Offer her a transvaginal ultrasound scan to determine the location of the pregnancy between 7 and 14 days later. Consider an earlier scan for women with a serum hCG level greater than or equal to 1,500 IU/litre.
If a viable intrauterine pregnancy is confirmed, offer her routine antenatal care. See the NICE guideline on antenatal care.
If a viable intrauterine pregnancy is not confirmed, refer her for immediate clinical review by a senior gynaecologist. [2012]
For a woman with a decrease in serum hCG levels greater than 50% after 48 hours:
inform her that the pregnancy is unlikely to continue but that this is not confirmed and
provide her with oral and written information about where she can access support and counselling services; see also recommendation 1.1.3 for details of further information that should be provided
ask her to take a urine pregnancy test 14 days after the second serum hCG test, and explain that:
if the test is negative, no further action is necessary
if the test is positive, she should return to the early pregnancy assessment service for clinical review within 24 hours. [2012]
For a woman with a decrease in serum hCG levels less than 50%, or an increase less than 63%, refer her for clinical review in the early pregnancy assessment service within 24 hours. [2012, amended 2019]
For women with a pregnancy of unknown location, when using serial serum hCG measurements, do not use serum progesterone measurements as an adjunct to diagnose either viable intrauterine pregnancy or ectopic pregnancy. [2012]
Advise a woman with a confirmed intrauterine pregnancy with a fetal heartbeat who presents with vaginal bleeding, but has no history of previous miscarriage, that:
if her bleeding gets worse, or persists beyond 14 days, she should return for further assessment
if the bleeding stops, she should start or continue routine antenatal care. [2012, amended 2021]
Offer vaginal micronised progesterone 400 mg twice daily to women with an intrauterine pregnancy confirmed by a scan, if they have vaginal bleeding and have previously had a miscarriage. [2021]
If a fetal heartbeat is confirmed, continue progesterone until 16 completed weeks of pregnancy. [2021]
In November 2021, this was an off-label use of vaginal micronised progesterone. See NICE's information on prescribing medicines.
For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on progestogens for preventing miscarriage.
Full details of the evidence and the committee's discussion are in evidence review C: progestogens for preventing miscarriage.
Use expectant management for 7 to 14 days as the first-line management strategy for women with a confirmed diagnosis of miscarriage. Explore management options other than expectant management if:
the woman is at increased risk of haemorrhage (for example, she is in the late first trimester) or
she has previous adverse and/or traumatic experience associated with pregnancy (for example, stillbirth, miscarriage or antepartum haemorrhage) or
she is at increased risk from the effects of haemorrhage (for example, if she has coagulopathies or is unable to have a blood transfusion) or
there is evidence of infection. [2012]
Offer medical management to women with a confirmed diagnosis of miscarriage if expectant management is not acceptable to the woman. [2012]
Explain what expectant management involves and that most women will need no further treatment. Also provide women with oral and written information about further treatment options. [2012]
Give all women undergoing expectant management of miscarriage oral and written information about what to expect throughout the process, advice on pain relief and where and when to get help in an emergency. See also recommendation 1.1.3 for details of further information that should be provided. [2012]
If the resolution of bleeding and pain indicate that the miscarriage has completed during 7 to 14 days of expectant management, provide the woman or person with a urine pregnancy test to carry out at home 3 weeks after their miscarriage, and advise them to return for individualised care if it is positive. [2012, amended 2023]
Offer a repeat scan if after the period of expectant management, the bleeding and pain:
have not started (suggesting that the process of miscarriage has not begun) or
are persisting and/or increasing (suggesting incomplete miscarriage).
Discuss all treatment options (continued expectant management, medical management and surgical management) with the woman to allow her to make an informed choice. [2012]
Review the condition of a woman who opts for continued expectant management of miscarriage at a minimum of 14 days after the first follow‑up appointment. [2012]
In August 2023, the use of mifepristone and misoprostol in recommendations 1.5.11 and 1.5.13 was off label. See NICE's information on prescribing medicines.
For the medical management of missed miscarriage offer:
200 mg oral mifepristone and
48 hours later, 800 micrograms misoprostol (vaginal, oral or sublingual) unless the gestational sac has already been passed. [2012, amended 2023]
Advise the woman or person that if bleeding has not started within 48 hours after misoprostol treatment, they should contact their healthcare professional to determine ongoing individualised care. If there are concerns that they will not contact the service then there should be arrangements for the service to follow up with these individuals. [2012, amended 2023]
For the medical management of incomplete miscarriage, use a single dose of misoprostol 600 micrograms (vaginal, oral or sublingual). Misoprostol 800 micrograms can be used as an alternative to allow alignment of treatment protocols for both missed and incomplete miscarriage. [2012, amended 2023]
Do not offer mifepristone as a treatment for incomplete miscarriage. [2012, amended 2023]
Offer all women and people receiving medical management of miscarriage pain relief and anti-emetics as needed. [2012]
Inform women and people receiving medical management of miscarriage about what to expect throughout the process. Include the length and extent of bleeding, potential side effects of treatment including pain, diarrhoea and vomiting, and when and how to seek help. [2012, amended 2023]
Provide women and people who have had medical management of miscarriage with a urine pregnancy test to carry out at home 3 weeks after medical management of miscarriage unless they experience worsening symptoms, in which case advise them to return to the healthcare professional responsible for providing their medical management. [2012, amended 2021]
Advise women and people with a positive urine pregnancy test after 3 weeks to return for a review to the healthcare professional responsible for providing their medical management to rule out a retained pregnancy, molar or ectopic pregnancy, and assess the need for further investigations or treatment. [2012, amended 2023]
If the pregnancy test after 3 weeks is negative but the woman or person is still bleeding heavily or has other symptoms (for example, pelvic pain or fever), then assess the need for further investigations or treatment. [2023]
For a short explanation of why the committee made the 2023 recommendations and how they might affect practice, see the rationale and impact section on medical management of miscarriage.
Full details of the evidence and the committee's discussion are in evidence review D: medical management of miscarriage.
Where clinically appropriate, offer women undergoing a miscarriage a choice of:
manual vacuum aspiration under local anaesthetic in an outpatient or clinic setting or
surgical management in a theatre under general anaesthetic. [2012]
Provide oral and written information to all women undergoing surgical management of miscarriage about the treatment options available and what to expect during and after the procedure. See also recommendation 1.1.3 for details of further information that should be provided. [2012]
Give all women with an ectopic pregnancy oral and written information about:
the treatment options and what to expect during and after treatment
how they can contact a healthcare professional for advice after treatment if needed, and who this will be
where and when to get help in an emergency.
See also recommendation 1.1.3 for details of further information that should be provided. [2012, amended 2019]
Inform women who have had an ectopic pregnancy that they can self-refer to an early pregnancy assessment service in future pregnancies if they have any early concerns. [2012]
Offer expectant management as an option to women who:
are clinically stable and pain free and
have a tubal ectopic pregnancy measuring less than 35 mm with no visible heartbeat on transvaginal ultrasound scan and
have serum hCG levels of 1,000 IU/L or less and
are able to return for follow-up. [2019]
Consider expectant management as an option for women who:
are clinically stable and pain free and
have a tubal ectopic pregnancy measuring less than 35 mm with no visible heartbeat on transvaginal ultrasound scan and
have serum hCG levels above 1,000 IU/L and below 1,500 IU/L and
are able to return for follow-up. [2019]
For women with a tubal ectopic pregnancy being managed expectantly, repeat hCG levels on days 2, 4 and 7 after the original test and:
if hCG levels drop by 15% or more from the previous value on days 2, 4 and 7, then repeat weekly until a negative result (less than 20 IU/L) is obtained or
if hCG levels do not fall by 15%, stay the same or rise from the previous value, review the woman's clinical condition and seek senior advice to help decide further management. [2019]
Advise women that, based on limited evidence, there seems to be no difference following expectant or medical management in:
the rate of ectopic pregnancies ending naturally
the risk of tubal rupture
the need for additional treatment, but that they might need to be admitted urgently if their condition deteriorates
health status, depression or anxiety scores. [2019]
Advise women that the time taken for ectopic pregnancies to resolve and future fertility outcomes are likely to be the same with either expectant or medical management. [2019]
For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on expectant management of tubal ectopic pregnancy.
Full details of the evidence and the committee's discussion are in evidence review B: expectant versus medical management of ectopic pregnancy.
In April 2019, the use of methotrexate in recommendations 1.6.8 to 1.6.11 was off label. See NICE's information on prescribing medicines.
Offer systemic methotrexate to women who:
have no significant pain and
have an unruptured tubal ectopic pregnancy with an adnexal mass smaller than 35 mm with no visible heartbeat and
have a serum hCG level less than 1,500 IU/litre and
do not have an intrauterine pregnancy (as confirmed on an ultrasound scan) and
are able to return for follow-up.
Methotrexate should only be offered on a first visit when there is a definitive diagnosis of an ectopic pregnancy, and a viable intrauterine pregnancy has been excluded. Offer surgery where treatment with methotrexate is not acceptable to the woman. [2012, amended 2019]
Offer surgery as a first-line treatment to women who are unable to return for follow-up after methotrexate treatment or who have any of the following:
an ectopic pregnancy and significant pain
an ectopic pregnancy with an adnexal mass of 35 mm or larger
an ectopic pregnancy with a fetal heartbeat visible on an ultrasound scan
an ectopic pregnancy and a serum hCG level of 5,000 IU/litre or more. [2012]
Offer the choice of either methotrexate or surgical management to women with an ectopic pregnancy who have a serum hCG level of at least 1,500 IU/litre and less than 5,000 IU/litre, who are able to return for follow‑up and who meet all of the following criteria:
no significant pain
an unruptured ectopic pregnancy with an adnexal mass smaller than 35 mm with no visible heartbeat
no intrauterine pregnancy (as confirmed on an ultrasound scan).
Advise women who choose methotrexate that their chance of needing further intervention is increased and they may need to be urgently admitted if their condition deteriorates. [2012]
For women with ectopic pregnancy who have had methotrexate, take 2 serum hCG measurements in the first week (days 4 and 7) after treatment and then 1 serum hCG measurement per week until a negative result is obtained. If hCG levels plateau or rise, reassess the woman's condition for further treatment. [2012]
When surgical treatment is indicated for women with an ectopic pregnancy, it should be performed laparoscopically whenever possible, taking into account the condition of the woman and the complexity of the surgical procedure. [2012]
Surgeons providing care to women with ectopic pregnancy should be competent to perform laparoscopic surgery. [2012]
Commissioners and managers should ensure that equipment for laparoscopic surgery is available. [2012]
Offer a salpingectomy to women undergoing surgery for an ectopic pregnancy unless they have other risk factors for infertility. [2012]
Consider salpingotomy as an alternative to salpingectomy for women with risk factors for infertility such as contralateral tube damage. [2012]
Inform women having a salpingotomy that up to 1 in 5 women may need further treatment. This treatment may include methotrexate and/or a salpingectomy. [2012]
For women who have had a salpingotomy, take 1 serum hCG measurement at 7 days after surgery, then 1 serum hCG measurement per week until a negative result is obtained. [2012]
Advise women who have had a salpingectomy that they should take a urine pregnancy test after 3 weeks. Advise women to return for further assessment if the test is positive. [2012]
Offer anti-D immunoglobulin prophylaxis at a dose of 250 IU (50 micrograms) to all rhesus-negative women who have a surgical procedure to manage an ectopic pregnancy or a miscarriage. [2012]
Do not offer anti‑D immunoglobulin prophylaxis to women who:
receive solely medical management for an ectopic pregnancy or miscarriage or
have a threatened miscarriage or
have a complete miscarriage or
have a pregnancy of unknown location. [2012]
Do not use a Kleihauer test for quantifying feto-maternal haemorrhage. [2012]
Pregnancy in the first trimester (that is, up to 13 completed weeks of pregnancy).
A management approach, also called 'wait and watch', when no medical or surgical treatment is given. The aim is to see if the condition will resolve naturally.
When a woman has a positive pregnancy test, but no intrauterine or extrauterine pregnancy can be seen with a transvaginal ultrasound scan.