Miscarriage care in Scotland: delivery framework
The delivery framework for Miscarriage Care in Scotland outlines a plan for introducing a graded model of miscarriage care. The Framework sets out 34 actions to help NHS Boards prioritise change locally and move to a ‘One Scotland’ approach.
Annex D
Miscarriage Diagnosis on Ultrasonography
An empty gestation sac with a mean sac diameter of 25 mm or more, or an embryo with a crown-rump length of 7 mm or more with no visible heart activity is considered to have sufficient accuracy for the diagnosis of miscarriage to justify management as miscarriage on a single scan.
If the diagnosis cannot be made on a single scan, a second ultrasound assessment is required 7-10 days later. At that scan failure to develop appropriately will allow the diagnosis of miscarriage to be made. This is because the exact date of conception is not known. However, in assisted conception the exact date of conception is known, and this can facilitate diagnosis on the first ultrasound scan.
Where the pregnancy is intrauterine, serial hCG assessment has no role in the diagnosis of miscarriage. The use of serial hCG assessment to make diagnostic decisions for miscarriage is not recommended and it is strongly advised to avoid their use for reassurance in the absence of an ultrasound scan for example in primary care.