Educational draft · awaiting clinical reviewThe full textbook explains uncertainty but does not replace live national or local guidance, specialist advice, or current prescribing information.
Communicate early-pregnancy uncertainty and loss honestly, preserve choice and dignity, and provide practical, psychological, cultural and safety follow-up without euphemism or assumptions.
Early-pregnancy loss can represent the loss of a hoped-for child, a frightening medical event, relief from an ambivalent pregnancy, or several feelings at once. Gestation does not predict emotional intensity. NICE requires dignity, respect, sensitive information tailored to the individual response and sufficient time, with an additional appointment when needed. The patient decides whether and how a partner, family member or friend is involved.
Good communication is clinically precise. If viability remains uncertain, say that a diagnosis cannot yet be made and give the exact repeat-scan plan; do not prematurely say miscarriage. Once diagnostic criteria are satisfied, avoid vague phrases such as the scan is not good. A clear statement followed by silence reduces confusion. Then move at the patient's pace through immediate safety, choices, practical arrangements and follow-up.
Bereavement care includes more than counselling. It covers pain and bleeding, remains and histology choices, cultural or spiritual rituals, certificates or local documentation where applicable, work and fit-note needs, lactation after later loss, contraception or trying again only when wanted, the expected return of menstruation, future pregnancy access and recognition of depression, anxiety or post-traumatic stress. Offer resources; never prescribe a single correct way to grieve.
Before naming miscarriage, verify the imaging or follow-up criteria and distinguish confirmed loss from intrauterine pregnancy of uncertain viability and pregnancy of unknown location.
Ask what this pregnancy and result mean to the person, what terms feel right and what they need now; do not infer response from gestation, parity or whether the pregnancy was planned.
Check language, hearing, vision, literacy, cognition and capacity needs. Use a qualified interpreter, accessible written material and supported decision-making rather than relatives as default interpreters.
A partner may also grieve, but disclosure and participation require the patient's consent. Speak to the patient alone when coercion, abuse or conflicting preferences are possible.
Normal grief fluctuates; persistent severe depression, panic, trauma, substance misuse, loss of function or self-harm thoughts indicate assessment and potentially urgent treatment rather than reassurance alone.
A direct, verified statement prevents the patient having to decode euphemisms and creates space for an honest response.
After giving the result, a deliberate pause lets information land and signals that emotion does not need to be hurried away.
When outcome is not yet known, exact timing, safety-netting and a named contact are more supportive than optimistic guessing.
Pregnancy, baby, embryo and tissue can carry different meanings; ask and mirror rather than correcting a grieving person.
Supporting a partner never overrides the patient's confidentiality, examination choices, treatment decision or wish for a private conversation.
Declining support today does not predict future need, so preserve an accessible route back without pathologising normal variation.
Announcing miscarriage before repeat-scan or PUL criteria have established the diagnosis safely.
Using euphemisms such as things do not look right and leaving the patient uncertain whether the pregnancy has ended.
Following the result immediately with a long list of procedures and medicines without pausing or checking what can be heard.
Saying at least it was early, you can try again or everything happens for a reason.
Assuming a partner may receive information or decide treatment because they attend the appointment.
Using a relative or child as interpreter for intimate, traumatic or safeguarding information.
Offering a leaflet without a 24-hour clinical contact, specific follow-up or discussion of physical danger signs.
Mistaking quiet behaviour for coping and omitting direct questions about trauma, functioning and suicide.
Pressuring counselling, ritual, contraception or immediate future conception discussion rather than following the patient's priorities.
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A wanted pregnancy has a transvaginal scan that does not yet meet diagnostic criteria for miscarriage. The patient asks whether the pregnancy has ended. Which response is best?
National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.
Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes