| Statement |
Level of agreement (%) |
| Patients with a threatened miscarriage should be managed expectantly without any medical or surgical interventions. However, patients should be given strict return precautions concerning excessive vaginal bleeding, abdominal pain, or fever and patients should be educated on the importance of follow up. |
11(100) |
| In clinically stable or asymptomatic patients, when suspicion of early pregnancy loss is being considered, a follow-up ultrasound scan should be booked after an additional 7–10 days until a viable intrauterine pregnancy is confirmed or until progression to an inevitable, incomplete, or complete abortion occurs. |
11(100) |
| In case of pain, analgesia can be provided to help relieve discomfort from cramping. NSAIDs should be avoided in the setting of threatened miscarriage. |
11(100) |
| Dydrogesterone 40 mg stat dose followed by 10 mg twice a day for one week or conservative therapy has been proven to reduce the incidence of pregnancy loss in threatened miscarriage during the first trimester. |
11(100) |
| Missed miscarriage can be defined with a crown-rump length >10 mm with no evidence of heart pulsations on two separate occasions at least 7 days apart. Whenever there is uncertainty about the viability of a pregnancy, a repeat scan at an interval of 1 week is necessary. |
10(90.9) |
| If on ultrasound the uterus is empty, there is adnexal mass, tubal ring, free fluid in the adnexa cul de sac area or complex fluid in the pelvis AND serum β-hCG value exceeds a discriminatory level of 1500–3000 mIU/mL, this is an indication for ectopic pregnancy. In addition, complete miscarriage should be considered if serum β-hCG is falling. |
11(100) |
| Proper management and control of diabetes and hypothyroidism if identified during pregnancy, should be addressed in prone women with threatened miscarriage in the first trimester. |
11(100) |
| It is recommended that patients start or continue to take prenatal vitamins with folic acid supplementation. A daily supplemental dose of 400 μg/day of folic acid is recommended. |
11(100) |
| Alloimmunization prevention by the administration of Rh(D) immunoglobulin should be considered for patients who have vaginal bleeding in the setting of pregnancy in a patient who is Rh-. It has been suggested that a 50 mcg dose of immunoglobulin is effective at alloimmunization prevention up to and through the 12th week of gestation, however, it is considered acceptable to give the standard 300 mcg dose due to non-availability of smaller dose. |
11(100) |
| Anti D prophylaxis should be offered to women with threatened miscarriage of less than 12 weeks gestation if the bleeding is recurrent, heavy and associated with abdominal pain. |
11(100) |
| Bedrest and other activity restrictions have not been found to be efficacious in the prevention of a threatened miscarriage progressing to spontaneous abortion and have been shown to increase the risk of other complications including deep vein thrombosis and/or pulmonary embolism and therefore should not be recommended. |
10(90.9) |
| Progesterone and human chorionic gonadotropin (hCG) are most commonly prescribed for women with threatened miscarriage. |
10(90.9) |
| Progesterone is advised to females who have experienced one or more prior pregnancy losses and have bleeding early in the current pregnancy. |
9(81.8) |
| The available evidence suggests that Folic acid supplements are essential. |
11(100) |
| Apart from Folic acid, routine vitamin B supplementation in females for threatened miscarriage is not essential. |
11(100) |
| Supplementation with low dose of vitamin D seems to be beneficial for threatened miscarriage, and a randomized double-blinded study showed that supplementation with vitamin D3 (400 IU/day) led to a decreased incidence of miscarriage. |
11(100) |
| Apart from folic acid, taking vitamin supplements in early pregnancy does not prevent miscarriage. |
11(100) |
