# Miscarriage - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Early Pregnancy Loss (Spontaneous Abortion) - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK560521/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class WD65 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · MSF Medical Guidelines, PARACETAMOL = ACETAMINOPHEN oral - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Miscarriage - disease-level clinical article (miscarriage-clinical.txt) ## Treatment metadata - No drug therapy in primary care (Referral & Advice) - Paracetamol — 500 mg — oral.solid ## Complete treatment card ```text MISCARRIAGE Sources: Early Pregnancy Loss (Spontaneous Abortion) - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK560521/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class WD65 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · MSF Medical Guidelines, PARACETAMOL = ACETAMINOPHEN oral Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Miscarriage - disease-level clinical article (miscarriage- clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Cramping and pelvic pain, plus how much bleeding and how many pads or tampons are used per hour, should be asked about [abdominal pain · bleeding · muscle cramps · pelvic pain] - Passing clots or tissue points to incomplete pregnancy loss, though the patient may not notice tissue or may mistake a clot for it - Heavy bleeding is often defined as soaking one to two pads an hour for two hours [bleeding] - Pain from an incomplete loss is often severe, unrelenting cramping much like a bad period [muscle cramps] - Anxiety can heighten how much pain the patient perceives [anxiety] SIGNS - what you find (5) - Fast heart rate and low blood pressure point toward haemorrhage from heavy uterine bleeding [bleeding · hypotension · tachycardia] - Fever raises concern for infection and a possible septic miscarriage needing urgent obstetric care [fever · sepsis] - An open cervical opening with tissue visible or protruding is typical of incomplete pregnancy loss - Pus-like discharge together with uterine tenderness strongly suggests infection [abdominal pain · pelvic pain · pus] - Rebound tenderness, guarding, or rigidity on abdominal exam calls for urgent surgical review [guarding · rebound tenderness] TESTS (10) - Transvaginal ultrasound is the preferred imaging test for a suspected pregnancy loss - A crown-rump length over 7 mm with no heartbeat, or an empty sac averaging over 25 mm, diagnoses a nonviable pregnancy with 100% specificity - Newer guidance favours a higher cut-off above 3,500 mIU/mL, since normal pregnancies can still be seen below the older figure - A slow rise or a fall in beta-hCG before its plateau can point to a failing or abnormal pregnancy - In an ectopic pregnancy, beta-hCG can fall before rising again, and rupture can happen even while levels are falling - When the picture stays unclear in a stable patient, ultrasound and beta-hCG are repeated, typically every 48 hours - Haemoglobin and haematocrit are checked at presentation to screen for blood-loss anaemia - Blood type and Rh(D) status are checked in case a transfusion or Rh(D) immune globulin is needed - Passed pregnancy tissue is sent for histology to confirm the loss and check for a molar pregnancy - If sepsis is suspected, add a full blood count, metabolic panel, lactate, and blood, urine, and cervical cultures IF NOT THIS - what else fits (3) - Other differentials for bleeding in pregnancy include ectopic pregnancy, complete or threatened miscarriage, and subchorionic haemorrhage - Also considered are molar pregnancy, non-obstetric bleeding such as trauma or polyps, and vaginal or cervical infection - Septic abortion, haemorrhagic or cervical shock, and uterine rupture are also on the list Source StatPearls "Incomplete Miscarriage" - disease-level clinical article Status traced to the source above Rx: Main treatment | Pain relief while the miscarriage is managed MAIN TREATMENT 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult Miscarriage is a common pregnancy complication; the GP recognises the presentation (bleeding, cramping, passage of tissue) and refers for ultrasound confirmation and management, which may be expectant, medical, or surgical. - Refer, with advice Peds Adult-only condition - paediatric section not applicable Source No dose - referral pathway, no medicine given in primary care Why Miscarriage is a common pregnancy complication; the GP recognises the presentation (bleeding, cramping, passage of tissue) and refers for ultrasound confirmation and management, which may be expectant, medical, or surgical. Caution Heavy bleeding with haemodynamic instability, or signs of infection (fever, foul discharge) after a miscarriage, need emergency referral. No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. RED FLAG - Tell the patient to seek care straight away if the bleeding soaks 1 to 2 pads an hour and keeps up at that rate for 2 hours, if over-the-counter painkillers are not controlling the pain, or if fever, dizziness or light-headedness develops. PAIN RELIEF WHILE THE MISCARRIAGE IS MANAGED - give alongside 2. PARACETAMOL [add-on - not a substitute] Adult 1 g three or four times a day, never more than 4 g in a day Peds Adult-only condition - paediatric section not applicable Source MSF Medical Guidelines, PARACETAMOL = ACETAMINOPHEN oral - verbatim: "Adult: 1 g 3 or 4 times daily (max. 4 g daily)" Why The card sends the woman on for assessment but offers her nothing for the cramping in the meantime, which can be considerable. Paracetamol is the safest analgesic to hand her, costs almost nothing, and does not affect bleeding. Caution Never exceed the daily maximum; overdose damages the liver badly and the early symptoms are mild enough to be missed. Check what else she is taking - many Egyptian cold, flu and painkiller boxes already contain paracetamol, and the doses add up. Use a lower daily total in a woman with liver disease or who drinks heavily. Pain that is severe, one-sided, or comes with shoulder-tip pain, fainting or heavy bleeding is not a job for analgesia - it needs urgent assessment for ectopic pregnancy or haemorrhage. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)