Diagnosis of Miscarriage and Services Available
The following sections will explain the relevant health care providers as well as the departments in the Cork University Maternity Hospital that women can attend when they experience symptoms of miscarriage. We will also discuss the role and function each of these departments has in helping you deal with a miscarriage.
Role of the GP
Your GP’s Surgery or South Doc is the first place to contact/attend if you are experiencing mild to moderate vaginal bleeding or abdominal pain in early pregnancy. Your GP may already be aware of your pregnancy. They will ask you details of your symptoms and your relevant medical history. A physical examination may also be necessary to determine a diagnosis. If your GP considers you need further investigations, they will refer you to the Emergency Room or to the Early Pregnancy Assessment Unit/Aislinn Suite in CUMH.
Role of the Emergency Room
The Emergency Room in CUMH is the first place to attend if you are having heavy vaginal bleeding or severe abdominal pain in pregnancy. Here the midwives will take a brief history and may take some blood tests depending on your symptoms. A doctor will see you and they will take a medical history, perform a physical examination to determine your care pathway. If you are physically stable you may be allowed to return home.
An appointment to the Early Pregnancy Assessment Unit/Aislinn Suite will be arranged for you and will take place a day or so after discharge. Limited scans are performed in the Emergency Room. The optimal time for an early pregnancy scan is 8 weeks gestation as it will provide the most accurate picture of pregnancy. An ultrasound scan may be necessary prior to this, however, a definitive diagnosis may not be possible.
Early Pregnancy Assessment Unit (EPAU)/The Aislinn Suite
The EPAU/Aislinn Suite is located on the second floor in CUMH. As you enter the maternity hospital through the main door, go straight through the double brown doors in front of you and you will get to a set of stairs and a lift. Go to second floor and follow direction for ward 2 South. Aislinn Suite is on your right after you enter Ward 2 South.
Sometimes the diagnosis of miscarriage is uncertain after one ultrasound scan. If the ultrasound is inconclusive a repeat scan will be offered to you 7 to 10 days later. Sometimes it is not possible to give a diagnosis after one ultrasound. At this early stage it can be difficult to differentiate between an early normal pregnancy and an early failing pregnancy. The only way that the medical team can give you a diagnosis is to repeat the ultrasound in 7-10 days. If they do it sooner than this, it may still be inconclusive. This is designed to protect an early pregnancy from being incorrectly labelled as a miscarriage.
Some patients experience bleeding during this 7-10 day waiting time. It is not essential to attend the hospital if this occurs unless the bleeding is very heavy (i.e. you need to change a sanitary towel every 30 to 60 minutes) or the pain is severe (i.e. not relived by painkillers).
If a diagnosis of miscarriage is confirmed the medical team will advise you on the appropriate management of your miscarriage in line with local and national guidelines. It is important to remember this is your decision and the doctor and midwife are there to offer support and information.
Blood tests will sometimes be used to give doctors more information about your pregnancy. The pregnancy hormone or HCG is a blood test that can be performed in early pregnancy.
This is done when:
an ultrasound scan is inconclusive
the gestation of a pregnancy is unknown
there is a query that the pregnancy is not in the right location i.e. in a suspected ectopic pregnancy
Two or more results are needed, usually 48 hours apart, in order to accurately interpret the test. If the HCG increases by more than 60% in 48 hours this is reassuring and is likely to be associated with a healthy viable pregnancy. If the HCG decreases by more than 15%, this suggests a likely miscarriage. It is important that blood results are interpreted in conjunction with a detailed history, a clinical exam and if medically indicated, an ultrasound scan.
In all cases, the blood HCG test is performed to help the medical team to plan the appropriate care for you.