This should not be based on an ultrasound diagnosis. Women who present with heavy vaginal bleeding with clots and undergo an ultrasound scan which suggests a complete miscarriage (i.e. an empty uterus with an endometrial thickness less than 15 mm), should be followed up with serum hCG levels until the diagnosis is established.24 We have described
how 5.9% of women with an apparent complete miscarriage have an underlying ectopic pregnancy. A diagnosis of complete miscarriage based on history and scan findings alone is unreliable. Our data highlight the need to classify these cases as PULs. The term 'complete miscarriage' should no longer be used in the context of an ultrasound scan report. All such women should be managed under the umbrella term of PUL until serum hCG levels demonstrate the outcome of the pregnancy. In the most recent CEMD, one potentially avoidable death was in a woman in whom an ultrasoni-cally empty uterus was interpreted as showing a complete miscarriage. According to the CEMD, 'quantitative hCG testing would certainly have established the correct diagno-
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