Dawaa Reference

chronic

Miscarriage

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

Early Pregnancy Loss (Spontaneous Abortion) - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK560521/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class WD65 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · MSF Medical Guidelines, PARACETAMOL = ACETAMINOPHEN oral

Verified against2 documents
  • No dose - referral pathway, no medicine given in primary care
  • Miscarriage - disease-level clinical article (miscarriage-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

  • Cramping and pelvic pain, plus how much bleeding and how many pads or tampons are used per hour, should be asked about [abdominal pain · bleeding · muscle cramps · pelvic pain]
  • Passing clots or tissue points to incomplete pregnancy loss, though the patient may not notice tissue or may mistake a clot for it
  • Heavy bleeding is often defined as soaking one to two pads an hour for two hours [bleeding]
  • Pain from an incomplete loss is often severe, unrelenting cramping much like a bad period [muscle cramps]
  • Anxiety can heighten how much pain the patient perceives [anxiety]

Signs — what you find (5)

  • Fast heart rate and low blood pressure point toward haemorrhage from heavy uterine bleeding [bleeding · hypotension · tachycardia]
  • Fever raises concern for infection and a possible septic miscarriage needing urgent obstetric care [fever · sepsis]
  • An open cervical opening with tissue visible or protruding is typical of incomplete pregnancy loss
  • Pus-like discharge together with uterine tenderness strongly suggests infection [abdominal pain · pelvic pain · pus]
  • Rebound tenderness, guarding, or rigidity on abdominal exam calls for urgent surgical review [guarding · rebound tenderness]

Tests (10)

  • Transvaginal ultrasound is the preferred imaging test for a suspected pregnancy loss
  • A crown-rump length over 7 mm with no heartbeat, or an empty sac averaging over 25 mm, diagnoses a nonviable pregnancy with 100% specificity
  • Newer guidance favours a higher cut-off above 3,500 mIU/mL, since normal pregnancies can still be seen below the older figure
  • A slow rise or a fall in beta-hCG before its plateau can point to a failing or abnormal pregnancy
  • In an ectopic pregnancy, beta-hCG can fall before rising again, and rupture can happen even while levels are falling
  • When the picture stays unclear in a stable patient, ultrasound and beta-hCG are repeated, typically every 48 hours
  • Haemoglobin and haematocrit are checked at presentation to screen for blood-loss anaemia
  • Blood type and Rh(D) status are checked in case a transfusion or Rh(D) immune globulin is needed
  • Passed pregnancy tissue is sent for histology to confirm the loss and check for a molar pregnancy
  • If sepsis is suspected, add a full blood count, metabolic panel, lactate, and blood, urine, and cervical cultures

If not this — what else fits (3)

  • Other differentials for bleeding in pregnancy include ectopic pregnancy, complete or threatened miscarriage, and subchorionic haemorrhage
  • Also considered are molar pregnancy, non-obstetric bleeding such as trauma or polyps, and vaginal or cervical infection
  • Septic abortion, haemorrhagic or cervical shock, and uterine rupture are also on the list

SourceStatPearls "Incomplete Miscarriage" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Pain relief while the miscarriage is managed

MAIN TREATMENT

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

Miscarriage is a common pregnancy complication; the GP recognises the presentation (bleeding, cramping, passage of tissue) and refers for ultrasound confirmation and management, which may be expectant, medical, or surgical. - Refer, with advice

Paediatric dose

Adult-only condition - paediatric section not applicable

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Miscarriage is a common pregnancy complication; the GP recognises the presentation (bleeding, cramping, passage of tissue) and refers for ultrasound confirmation and management, which may be expectant, medical, or surgical.

Cautions
  • Heavy bleeding with haemodynamic instability, or signs of infection (fever, foul discharge) after a miscarriage, need emergency referral.
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
  • RED FLAG - Tell the patient to seek care straight away if the bleeding soaks 1 to 2 pads an hour and keeps up at that rate for 2 hours, if over-the-counter painkillers are not controlling the pain, or if fever, dizziness or light-headedness develops.

PAIN RELIEF WHILE THE MISCARRIAGE IS MANAGED - give alongside

2

PARACETAMOL

Pain relief while the miscarriage is managed

add-on - not a substitute

Strength500 mg

Formoral.solid

Adult dose and duration

1 g three or four times a day, never more than 4 g in a day

Paediatric dose

Adult-only condition - paediatric section not applicable

Dose source

MSF Medical Guidelines, PARACETAMOL = ACETAMINOPHEN oral - verbatim: "Adult: 1 g 3 or 4 times daily (max. 4 g daily)"

Why

The card sends the woman on for assessment but offers her nothing for the cramping in the meantime, which can be considerable. Paracetamol is the safest analgesic to hand her, costs almost nothing, and does not affect bleeding.

Cautions
  • Never exceed the daily maximum; overdose damages the liver badly and the early symptoms are mild enough to be missed.
  • Check what else she is taking - many Egyptian cold, flu and painkiller boxes already contain paracetamol, and the doses add up.
  • Use a lower daily total in a woman with liver disease or who drinks heavily.
  • Pain that is severe, one-sided, or comes with shoulder-tip pain, fainting or heavy bleeding is not a job for analgesia - it needs urgent assessment for ectopic pregnancy or haemorrhage.
Egyptian brands
Egyptian brandManufacturerIndicative price
FEBRIMOL 500 MG 20 TAB.PHARCO3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.MEMPHIS8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.MUP13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.EIPICO24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.UTOPIA42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.MISR38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETSJULPHAR32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETSAUG PHARMA50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidPHAROPHARMA5.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.