Skip to main content

Retained Products of Conception and Miscarriage

Question# 743

We had a patient that had a miscarriage this am, she was 3 months gestation. She had started to have vaginal bleeding 4 days ago. She was examined at civic on Saturday, after an ultrasound was informed that there was no heart sounds.

My partner informed me that we needed to retrieve the tissues in the toilet and bring them to the er .

Can you please clarify that this is that is the correct procedure, I was unable to find anywhere in the BLS what is the appropriate procedure.

Could you also give me the appropriate term that this should be referred to. The er Dr referred to it as tissue of conception.

If we are to retrieve it from the toilet what tool are we expected to retrieve the blood clots .

I have responded to a miscarriage that was 16 weeks that I I had to cut the umbilical cord , that is a totally different situation and brought the fetus to the er .

I would appreciate a clarification on this mater, looking forward to your response.

Answer:

Thank you for your MedicASK question.

This sounds like a challenging call, and it appears you and your partner approached it with care and compassion. Thank you and great work!

You are correct in stating that no where in the BLS does it mention to bring miscarriage tissue, blood clots, pads, etc. to the hospital however there are some circumstances that this is appropriate and feasible. More specifically, if you deliver a fetus and can wrap it in a blanket and bring it with the patient to the hospital, then that is an appropriate action. However, retrieving blood clots and other tissues out of a toilet are not necessary. A visualization and further documentation and report to the receiving hospital are acceptable. This should include approximate volume of blood loss, number and size of blood clots, any other visualized tissue products, a visible fetus, or fetal parts including size and shape.

Please do consider, however, that a birth prior to 20 weeks is called a miscarriage and with this time of even t there are no legal consequences related to the products. The birth of a fetus, with no vital signs, after 20 weeks is called a stillbirth and there are some medical and legal consequences associated with it. More specifically, for a birth after 20 weeks it is important to assess the fetus for signs of life and act accordingly. Additionally, if there are no vital signs there is a legal requirement for a death certificate, for the remains to be dispositioned through a funeral home, and the potential for a death investigation and/or coroner involvement.

A good reminder that if the gestational age is greater than 20 weeks or it is not clear/unknown, paramedics should be vigilant about examining the fetus for signs of life/viability and not assume a non-viable miscarriage.

Regarding your question about what to call the products of miscarriage, the following is the definition provided by UpToDate: the term retained products of conception (RPOC) refers to placental and/or fetal tissue that remains in the uterus after a spontaneous pregnancy loss (miscarriage), planned pregnancy termination, or preterm/term delivery.

Thank you for your continued dedication to patient care and advocacy.

RPPEO Education Coordinator

References

Published

08 November 2023

ALSPCS Version

5.2

Views

488

Please reference the MOST RECENT ALS PCS for updates and changes to these directives.