Symptoms of an imminent miscarriage. A prospective study by general practitioners and midwives

Objective: In 1989 the Dutch College of General Practitioners drew up national guidelines relative to imminent miscarriage. These guidelines are also used by midwives. A prospective recording study was carried out among primary health care patients to determine the course of imminent miscarriage symptoms. Setting: General and midwifery practices in The Netherlands. Methods: Over a period of 12 months, 75 GPs and 43 midwives recorded all patients (n=406) showing symptoms of imminent miscarriage. Among the items recorded were history taking, diagnostics, diagnosis, treatment and policy on follow-up care. Results: The main reason for contacting the GP or midwife was blood loss. The time between the onset of the symptoms and the contact with the GP or midwife ranged from immediately to 21 days and was related to the amount of blood loss. Among the patients with the diagnosis of miscarriage there was hardly any difference in symptoms between patients who underwent curettage and those who did not. In 24% of the cases in which the patient underwent curettage the GP or midwife stated that they believed it was not necessary. But the obstetrician had assumed control after they had requested an ultrasound scan. In seven patients ectopic pregnancy or molar pregnancy was diagnosed. The course of the symptoms in these patients is described. Conclusion: The course the symptoms of imminent miscarriage seems not to be serious. GPs and midwives are able to trace complications such as an ectopic pregnancy or molar pregnancy provided they adhere to the guidelines.