Miscarriage Care and Facilities in Scotland: Scoping Report National Overview

Management options

The Lancet series on Miscarriage Matters states an effective early pregnancy service needs to be able to support women with expectant management, and provide medical management with mifepristone and misoprostol, and surgical management with manual vacuum aspiration.

In some Health Boards miscarriage management options are only available at one or two sites within the Health Board. The geography of provision means that some women may have to travel substantial distances to access any management option for miscarriage, including expectant management (Table 15).

There are differences in the management options that are available to women at different gestations throughout Scotland. For all Health Boards management options are discussed with women and considered for each individual case particularly in terms of the gestation at which the loss had occurred. While all Health Boards stated specific gestations at which a treatment option may be available to women, there is variation across Scotland in terms of what treatment options are offered at different gestions.

Expectant Management

Expectant management is offered in all Health Board areas. Expectant management is offered for first trimester losses in nine Health Boards with five Health Boards offering expectant management for first and second trimester losses.

Medical Management

Medical management with misoprostol is offered in all Health Board areas. Medical management with mifepristone and misoprostol is offered in all Health Board areas except NHS Fife.

Medical management with misoprostol is offered for first trimester losses in 5 Health Boards with 9 Health Boards offering this treatment for first and second trimester losses.

Medical management with mifepristone and misoprostol is offered for first and second trimester losses in 13 of the 14 Health Boards. In NHS Fife medical management with mifepristone and misoprostol is not offered instead multiple doses of misoprostol is offered for first and second trimester losses. In NHS Shetland and NHS Orkney medical management with mifepristone and misoprostol is offered in first trimester losses with second trimester losses being cared for in NHS Grampian where medical management with mifepristone and misoprostol is available for first and second trimester losses.

Surgical Management

All Health Boards offer surgical management with general anaesthetic and 10 of 14 Health Boards currently provide surgical management with manual vacuum aspiration (MVA) in at least one site in the Health Board area. One Health Board stated this service was being developed (NHS Borders).

Surgical management with manual vacuum aspiration (MVA) with local anaesthetic is offered for first trimester losses in 10 Health Board areas. In NHS Borders and NHS Fife MVA is not provided in the Health Board area but can be accessed in another Health Board area. In NHS Lothian MVA is not provided due to lack of physical space and staff training. In NHS Shetland MVA is not currently offered for first trimester losses.

Surgical management under general anaesthetic is available in all Health Boards in Scotland. This is offered for first trimester losses in 12 Health Boards. NHS Forth Valley and NHS Grampian offer surgical management under general anaesthetic for first and second trimester losses.

* While trimesters are referred to in the table the management option is often offered up to a specific gestation in weeks and days which may cover part of a trimester rather than the full trimester.

**NHS Orkney provide first trimester care with second trimester care referred to NHS Grampian

***NHS Shetland provide first trimester care with second trimester care referred to NHS Grampian