Abstract

Aims/Objectives

The aim of this audit was to assess the management of ultrasound diagnosed first trimester missed miscarriage in CUMH against national standards (National Clinical Practice Guideline: First Trimester Miscarriage. National Women and Infants Health Programme and The Institute of Obstetricians and Gynaecologists. March 2025).

Methods

Retrospective audit of all women diagnosed with a first trimester missed miscarriage on departmental ultrasound in CUMH in a single month: November 2025. All cases were reviewed against national standards. Approval for this project was granted by the CUMH RAAC Committee (Ref: 202710).

Results

There were 483 first trimester departmental ultrasounds performed in CUMH in November 2025 and of these there were 42 cases (8.7%) of first trimester missed miscarriage. Median maternal age was 35 years and median maternal BMI was 26 kg/m2.  Referral source was private rooms/fertility clinics in 40%, self/GP in 35% and the CUMH emergency department in 25%. Diagnosis of missed miscarriage was entered in the electronic health care record in 50%, while 76.2% were provided with emergency contact information and 100% were provided with written information and at time of diagnosis. Management options employed were outpatient/ inpatient medical (57.2%), surgical (28.6%) and conservative (14.3%). Further intervention to achieve complete treatment was required in 19%. Incidence of subsequent unscheduled emergency presentation was 14.3%. 

Discussion

This is the first audit of ultrasound-diagnosed first trimester missed miscarriage in CUMH. It has identified key areas for improvement and provided information for local education. A benchmark has also been established for future bi-annual audits.