Early pregnancy concerns are among the most stressful consultations. The RCOG guideline on early pregnancy complications provides a systematic framework for triage, diagnosis, and safety-netting. Here’s the summary clinicians most often search for.

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1) Red flags requiring same-day assessment

  • Heavy bleeding or haemodynamic instability.
  • Severe or worsening abdominal pain.
  • Shoulder tip pain or collapse → possible ectopic.
  • Abdominal pain + positive pregnancy test + no intrauterine pregnancy on scan.

2) First-line investigations

  • Urine pregnancy test.
  • Transvaginal ultrasound.
  • Serum β-hCG if scan inconclusive — correlate scan findings with hCG patterns.

3) Miscarriage types and management

  • Threatened miscarriage: Bleeding with closed cervix → expectant management + safety netting.
  • Incomplete miscarriage: Products of conception remain → expectant, medical (misoprostol), or surgical evacuation.
  • Missed miscarriage: Fetal pole present, no cardiac activity → offer patient-centred choice of management.
  • Complete miscarriage: No further treatment required; provide emotional support and safety netting.

4) Ectopic pregnancy

  • Suspect with pain + bleeding + pregnancy, or empty uterus on scan + hCG above discriminatory zone (~1500 IU/L).
  • Management: expectant (rare), methotrexate, or surgical.
  • Methotrexate contraindications include breastfeeding, liver disease, significant pain, or high initial hCG.

5) Safety netting essentials

  • Advise return for increasing pain, dizziness, heavy bleeding.
  • Provide contact details for the early pregnancy assessment unit.
  • Clarify expected bleeding and what is abnormal.

6) Anti-D administration

  • Offer to Rh-negative women with miscarriage, ectopic pregnancy, or surgical/medical evacuation.
  • Not required for threatened miscarriage without bleeding.

If you need more detail (e.g., local EPAU thresholds or methotrexate pathways), let us know and we’ll add a Trust-specific note.