Miscarriage Care and Facilities in Scotland: Scoping Report National Overview

Findings

Miscarriage care services in Scotland

In Scotland women experiencing miscarriage present at many different locations. This includes: GP practices, Accident and Emergency (A&E) departments, Maternity Units, Community Maternity units (CMU)^[5], Early Pregnancy Units (EPU), and midwifery services more generally. Women call in advance or present in person for the first time at this range of settings.

Within the 14 Health Board areas in Scotland, numerous secondary care sites that could provide miscarriage care in Scotland were identified. These were checked by the lead professional for miscarriage care in each Health Board to ensure they were secondary care sites that may be the first point of contact for women experiencing miscarriage. This resulted in 44 sites being identified. The sites are listed in Annex B. Table 1 shows the number of sites identified for each Health Board.

Table 2 below lists the secondary care services that the 44 sites that took part in this scoping exercise said were available at each site within the 14 Health Board areas.

Services within Health Board Areas

Where most women present for the first time when experiencing a miscarriage differs depending on location in Scotland. The main services where women present include Accident and Emergency departments, general practice, midwifery teams, Community Midwifery Unit, Midwifery Unit or Early Pregnancy Unit (EPU). Table 3 below outlines the sites identified for this study where women may present and where those sites said women experiencing miscarriage should initially be seen in each Health Board area.

Women are triaged and then cared for within the service where they initially present or are transferred or referred to another site, most often to an EPU or maternity services.

Victoria Hospital, Mull & Iona Community Hospital, Mid Argyll Community Hospital and Integrated Care Centre, Lorn & Islands Hospital, Islay Hospital, Cowal Community Hospital (A&E) and Campbeltown Hospital are all located in Argyll and Bute. Although these sites are part of NHS Highland, the services for miscarriage care and pregnancy complications are provided jointly through the local community maternity units and general practice in NHS Highland and via a service level agreement with NHS Greater Glasgow and Clyde. As the same pathway of care is used across all sites in Argyll and Bute these sites have been grouped together in the report. The services provided in this area are explained in more detail in the report Miscarriage care and facilities in Scotland: scoping report - NHS Highland.

In NHS Orkney, all maternity services are operated from one Maternity Unit. Early pregnancy services are incorporated into the whole service and as such are not classed as a separate dedicated provision. The services typically provided by an early pregnancy unit are provided through the whole service approach adopted at Balfour Hospital. Balfour Hospital indicated that although women mainly prefer to access the support and expertise of the maternity team within the Maternity Unit, options are available for alternative accommodation in the acute or day surgery wards if women prefer not to attend the Maternity Unit. Regardless of where women are located within Balfour Hospital, access to midwifery care is always available. NHS Orkney provides management options for women experiencing miscarriage in the first trimester with second trimester miscarriage management referred to NHS Grampian.

NHS Shetland reported that all women present at Gilbert Bain Hospital when experiencing a miscarriage. NHS Shetland provides miscarriage care from Gilbert Bain Hospital Maternity Unit. However, only first trimester losses, up to 12 weeks gestation, are managed within NHS Shetland; second trimester miscarriage management is referred to NHS Grampian. In NHS Shetland building work has commenced on a new bereavement suite for parents which will enable care to be offered up to 22 weeks gestation.

*This includes all sites in Argyll and Bute (Victoria Hospital, Mull & Iona Community Hospital, Mid Argyll Community Hospital and Integrated Care Centre, Lorn & Islands Hospital, Islay Hospital, Cowal Community Hospital (A&E) and Campbeltown Hospital)