Miscarriage Care and Facilities in Scotland: Scoping Report National Overview

Summary

The overall summary is presented below and is shown in Annex A mapped to the recommendations within the Lancet series on Miscarriage Matters and the Scottish Government Programme for Government commitments. The findings will be used to aid in the development of an improvement plan for miscarriage care in Scotland.

Nationally, the approach to miscarriage care varies both between and within Health Board areas. Most health boards have identified core sites that provide care for women who experience miscarriage, however what is provided at these sites varies across Scotland.

Early pregnancy services are available in all Health Boards in Scotland, 10 of 14 Health Boards have a dedicated early pregnancy unit. The opening times of early pregnancy services varies across Scotland.

All sites said that women are free to choose the management approach that suits their needs, however the geography of provision in Scotland has implications for women in terms of how they can access their chosen approach. While expectant management is often available locally, for medical or surgical management women may have to travel to the nearest site that provides this service and this can be some distance away, particularly in more rural areas.

While progress has been made towards a graded approach to miscarriage care, this approach has not yet been fully adopted in any Health Board in Scotland. That said, where elements of the graded approach have been adopted, progress is being made towards more comprehensive care for women experiencing miscarriage.

After a first, second and third or subsequent miscarriage, the full service provision outlined in the Lancet is not yet being provided in any of the Health Boards in Scotland. Key elements of the graded approach such as the provision of vaginal micronised progesterone and medical management with mifepristone and misoprostol and surgical manual vacuum aspiration have not yet been fully implemented in all Health Boards.

All Health Board areas provide some dedicated facilities for those experiencing unexpected pregnancy complications, although not all have separate rooms or areas away from women with a continuing pregnancy. Those that do not have separate areas indicated that this was mainly due to lack of space and that they plan to implement such facilities in the next two years.

Half of the Health Boards have a separate area to carry out complication/

investigative scans which are separate from women with a continuing pregnancy, while some sites plan to implement this, others stated space and costs as a barrier to implementation.

There is written clinical guidance for clinical staff on the appropriate treatment and care for miscarriage at all gestations at most sites that care for women experiencing miscarriage.

The training and skills of staff providing miscarriage care varied across Health Boards. Often specialist training is centralised within one or two units within a Health Board area. Some Health Boards operate a medically led approach to miscarriage care with consultant lead provision and doctors trained to provide comprehensive miscarriage care with fewer Health Boards with nurses or midwives with additional specialist training.

The gathering of data about miscarriage is variable both within and across Health Board areas, this has been difficult to capture centrally due to women presenting at both primary and secondary health care environments, alongside some women not presenting at all to medical services. A project is underway to better define and capture data on miscarriage nationally in Scotland in line with the Lancet series on miscarriage matters.