Synopsis
Offer confirmed miscarriage treatment in a clear sequence, using NICE first-line expectant care, exact medical regimens, surgical choices, emergency thresholds and completion follow-up.
- Confirm intrauterine miscarriage with safe ultrasound criteria before treatment; if location was never established, maintain PUL follow-up.
- NICE first-line for confirmed miscarriage is expectant management for 7–14 days, unless haemorrhage risk, prior traumatic experience, inability to tolerate bleeding or infection favours another option.
- For missed miscarriage, give mifepristone 200 mg orally, then 48 hours later misoprostol 800 micrograms vaginally, orally or sublingually unless the sac has passed.
Key red flags
Soaking pads rapidly with dizziness, collapse, tachycardia, hypotension or pallor indicates clinically important haemorrhage and requires emergency care.
Investigation priorities
Confirm intrauterine miscarriage and assess whether tissue remains before treatment.
Management branches
A confirmed uncomplicated miscarriage is stable and the patient accepts expectant management.
- Explain likely bleeding, pain, tissue passage, analgesia, remains options and exact emergency thresholds and provide written 24-hour contact information.
- Review at 7–14 days: if symptoms resolved, supply a three-week urine test; if they never began or persist, repeat ultrasound and discuss all three options again.
There is haemorrhage, infection, conservative-treatment failure, contraindication or a clear preference for procedural completion.
Key medicines
Mifepristone plus misoprostol for missed miscarriageGive mifepristone 200 mg orally once, followed 48 hours later by misoprostol 800 micrograms vaginally, orally or sublingually unless the gestational sac has already passed.
Misoprostol for incomplete miscarriageGive misoprostol 600 micrograms vaginally, orally or sublingually once; an 800 microgram single dose may be used to align missed and incomplete miscarriage protocols.