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24/09/2015
The research, which has been carried out by a team at Imperial College London and published in the BMJ.
Currently, the standard for a suspected miscarriage diagnosis requires a single ultrasound scan, or two scans, with the second being carried out after seven days. However, researchers have suggested that if women with a suspected miscarriage are offered two scans up to 14 days apart, then doctors can be confident that their diagnosis is correct. They add that an accurate diagnosis is vital, as a misdiagnosis could result in a healthy pregnancy being inadvertently terminated.
Miscarriage is quite common during the first trimester of pregnancy. In the UK, expectant mothers who experience pain or bleeding in the first three months of pregnancy are referred to an early pregnancy clinic where they receive an ultrasound. In some cases, the scan can reveal if the woman has suffered a miscarriage.
When a miscarriage is diagnosed, a woman and her doctor can choose to wait and let the miscarriage progress naturally, or choose a medical or surgical intervention to speed up the process. Because of this, accuracy is vital, the team explained.
Currently, guidelines say miscarriage may be diagnosed on a single ultrasound scan based on the measurements of either an empty gestational sac, or an embryo where a heartbeat has not been visualised.
These guidelines were established in 2011, following a study by Professor Tom Bourne, from Imperial College London's Department of Surgery and Cancer, and his team, who are also behind this latest research. The previous study looked at the possibility of some women being wrongly diagnosed with miscarriage, and since the introduction of the guidelines, the risk of misdiagnosis has reduced – but improvements remain, the team has said.
This study involved 2,845 women who attended early pregnancy clinics across London due to pain, bleeding or severe morning sickness, or because they had previously experienced miscarriage or an ectopic pregnancy. Each woman received a scan which suggested the viability of the pregnancy was uncertain, and were asked to return after seven to 14 days for a second scan to determine whether the pregnancy was a miscarriage or an ongoing viable pregnancy.
While the criteria used to diagnose miscarriage on an initial scan are found to be safe, the research confirms that current advice on when to repeat scans – and what might be seen on such scans – is not reliable and therefore could lead to misdiagnosis. For example, repeating scans in seven days as per the current NICE guidance, was associated with a false positive rate approaching 2%.
The authors therefore recommend waiting up to 14 days in some cases before repeating a scan to decide if a pregnancy has miscarried. They also show that the gestational age of the pregnancy is important in obtaining an accurate diagnosis. Gestation sacs or embryos that are of uncertain viability on an initial scan are much more likely to miscarry if the gestational age is later, for example more than 10 weeks.
The recommendations mean that women may have to wait longer before knowing whether their pregnancy has miscarried or not, and while they acknowledge that this would cause anxiety, they added that clinicians need to explain to women at the first scan why they may not be given a firm diagnosis. Similarly, they said doctors should provide a realistic indication of the likely outcome at a follow-up scan.
Calls are now being made for NICE and the Royal College of Obstetrics and Gynaecology (RCOG) to update their guidelines for diagnosing miscarriage.
Professor Bourne said: "Women should be able to rely on a diagnosis of miscarriage. It's an area of medicine where the highest levels of caution are warranted.
"Just one misdiagnosis of miscarriage is too many. Although we have shown some aspects of the current guidelines are very good, our new study provides us with better data to guide clinicians and improve diagnostic accuracy."
(JP/LM)
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Calls To Improve Early Miscarriage Guidelines
A new study has claimed improvements are needed to the way early miscarriage is diagnosed.The research, which has been carried out by a team at Imperial College London and published in the BMJ.
Currently, the standard for a suspected miscarriage diagnosis requires a single ultrasound scan, or two scans, with the second being carried out after seven days. However, researchers have suggested that if women with a suspected miscarriage are offered two scans up to 14 days apart, then doctors can be confident that their diagnosis is correct. They add that an accurate diagnosis is vital, as a misdiagnosis could result in a healthy pregnancy being inadvertently terminated.
Miscarriage is quite common during the first trimester of pregnancy. In the UK, expectant mothers who experience pain or bleeding in the first three months of pregnancy are referred to an early pregnancy clinic where they receive an ultrasound. In some cases, the scan can reveal if the woman has suffered a miscarriage.
When a miscarriage is diagnosed, a woman and her doctor can choose to wait and let the miscarriage progress naturally, or choose a medical or surgical intervention to speed up the process. Because of this, accuracy is vital, the team explained.
Currently, guidelines say miscarriage may be diagnosed on a single ultrasound scan based on the measurements of either an empty gestational sac, or an embryo where a heartbeat has not been visualised.
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These guidelines were established in 2011, following a study by Professor Tom Bourne, from Imperial College London's Department of Surgery and Cancer, and his team, who are also behind this latest research. The previous study looked at the possibility of some women being wrongly diagnosed with miscarriage, and since the introduction of the guidelines, the risk of misdiagnosis has reduced – but improvements remain, the team has said.
This study involved 2,845 women who attended early pregnancy clinics across London due to pain, bleeding or severe morning sickness, or because they had previously experienced miscarriage or an ectopic pregnancy. Each woman received a scan which suggested the viability of the pregnancy was uncertain, and were asked to return after seven to 14 days for a second scan to determine whether the pregnancy was a miscarriage or an ongoing viable pregnancy.
While the criteria used to diagnose miscarriage on an initial scan are found to be safe, the research confirms that current advice on when to repeat scans – and what might be seen on such scans – is not reliable and therefore could lead to misdiagnosis. For example, repeating scans in seven days as per the current NICE guidance, was associated with a false positive rate approaching 2%.
The authors therefore recommend waiting up to 14 days in some cases before repeating a scan to decide if a pregnancy has miscarried. They also show that the gestational age of the pregnancy is important in obtaining an accurate diagnosis. Gestation sacs or embryos that are of uncertain viability on an initial scan are much more likely to miscarry if the gestational age is later, for example more than 10 weeks.
The recommendations mean that women may have to wait longer before knowing whether their pregnancy has miscarried or not, and while they acknowledge that this would cause anxiety, they added that clinicians need to explain to women at the first scan why they may not be given a firm diagnosis. Similarly, they said doctors should provide a realistic indication of the likely outcome at a follow-up scan.
Calls are now being made for NICE and the Royal College of Obstetrics and Gynaecology (RCOG) to update their guidelines for diagnosing miscarriage.
Professor Bourne said: "Women should be able to rely on a diagnosis of miscarriage. It's an area of medicine where the highest levels of caution are warranted.
"Just one misdiagnosis of miscarriage is too many. Although we have shown some aspects of the current guidelines are very good, our new study provides us with better data to guide clinicians and improve diagnostic accuracy."
(JP/LM)
Top stories
20/03/2020
LeToya Luckett-Walker Is Pregnant
Charlotte Crosby Finds New Romance
Lydia Bright Gets Candid About Giving Birth
Lana Del Ray Splits From Boyfriend
Angelica Ross Learns Of Boyfriend's Secret Life
Ashley Graham's Breastfeeding Struggle
Susanna Reid's Mother's Day Plans
Lin-Manuel Miranda Homeschooling Kids
Kristen Bell Speaks Of Pride For Daughters
Prince George & Princess Charlotte Now Homeschooled
