What criteria should I use to determine if a patient with a miscarriage requires referral to a specialist?

Criteria for referral to a specialist for a patient with miscarriage include:

• Presence of pain and/or bleeding in early pregnancy that requires assessment by a healthcare professional before referral to an early pregnancy assessment service (specialist) ¹.
• Clinical instability or significant symptoms such as heavy bleeding, pelvic pain, or fever after miscarriage, especially if symptoms worsen or new symptoms develop ¹.
• Positive pregnancy test after 3 weeks post-miscarriage requiring review to rule out retained products, molar or ectopic pregnancy, or need for further treatment ¹.
• Women with recurrent miscarriage or previous ectopic or molar pregnancy may self-refer directly to early pregnancy assessment services ¹.
• Need for ultrasound and serum hCG assessment to confirm diagnosis and guide management, which is typically available in specialist early pregnancy assessment services ¹.
• Women who are clinically unstable, have significant pain, or do not meet criteria for expectant management should be referred for specialist assessment ¹.

Referral should ensure access to a specialist early pregnancy assessment service that operates 7 days a week and can provide timely ultrasound and hCG testing, with staff trained in sensitive communication ¹.