Miscarriage Care and Facilities in Scotland: Scoping Report National Overview

Dedicated facilities

Unexpected pregnancy complications at any gestation

The Scottish Government committed to the provision of dedicated facilities for women experiencing unexpected pregnancy complications in the Programme for Government 2021-22^[7]. All sites in this scoping exercise were asked if they currently provide dedicated facilities for women experiencing unexpected pregnancy complications at any gestation. Sites with an EPU were also asked to indicate if they currently provide dedicated facilities for women experiencing unexpected pregnancy complications at any gestation within the EPU.

The Lancet series on miscarriage matters states 'we urge health-care funders and providers to invest in early pregnancy care, with specific focus on training for clinical nurse specialists and doctors to provide comprehensive miscarriage care within the setting of dedicated early pregnancy units.

All Health Boards in Scotland said they have dedicated facilities for women experiencing unexpected pregnancy complications. These facilities are most often provided in the early pregnancy unit where there is an EPU on site (Table 11). Where there is no EPU, at least one room is available for women experiencing unexpected pregnancy complications in the Health Board area.

While these dedicated facilities are available in all Health Board areas, some women may need to travel significant distances to access these facilities, particularly in more rural areas and in areas when miscarriage care is provided at one or two main locations within a Health Board area.

Separate room/area/ward

Eleven out of 14 Heath Boards in Scotland have a separate room/area/ward away from the labour ward for women experiencing miscarriage. The number of separate rooms available for women who are experiencing miscarriage ranges between 1 and 12 rooms. In most Health Boards these rooms are available on the gynaecology ward or on the maternity ward, where rooms are located away from the labour or postnatal rooms. It is noted that some rooms/areas are not solely used for miscarriage care and may be used for other pregnancy complications or loss (Table 11).

Three Health Board areas that stated they do not have a separate room/area/ward away from labour ward for women that are miscarrying, NHS Borders stated that they plan to implement this provision in the next two years. In NHS Orkney a room is available in the maternity unit away from the postnatal and labouring area and the acute ward can be used if preferred by the patient. In NHS Shetland building work is underway for a bereavement suite that will provide this space for women.

If women experiencing miscarriage need to be admitted for care, 10 of the 14 Health Boards stated a separate room/area/ward, separated from the labour ward with dedicated services is available to admit women who are miscarrying. These rooms are often in the gynaecological ward, EPU or bereavement suite. Of the Health Boards that stated a separate room/area/ward separated from the labour ward with dedicated services to admit women who are miscarrying is not provided, NHS Borders and NHS Shetland stated there are plans to implement this. In NHS Western Isles there are no rooms out with the maternity ward but women experiencing miscarriage are located away from the labour and main wards. In NHS Orkney women largely prefer to access the maternity unit. Options are available for alternative accommodation in the acute or day surgery wards where the support and expertise of the maternity team is still available if women prefer not to attend the maternity unit.

Scanning facilities

Scans are often performed to confirm a miscarriage has occurred. For this scoping exercise all of the 44 sites were asked if an area was available to carry out complication or investigative scans separated from women with a continuing pregnancy (Table 12).

Seven of the 14 Health Boards said that they have a separate area to carry out complication/investigative scans separated from women with a continuing pregnancy either within or out with the EPU. In most Health Board areas this provision is at the one main site in the Health Board area where most women that present with a miscarriage are seen. Only NHS Greater Glasgow and Clyde and NHS Lanarkshire have a separate area to carry out complication/investigative scans separated from women with a continuing pregnancy in more than one site.

Amongst the 17 EPUs, eight can carry out complication/investigative scans in an area separated from women with a continuing pregnancy. Of the remaining nine EPU sites, three sites have plans to implement this service within the EPU in the next two years and six sites have no plans to implement this service within the EPU. Of those with no plans to implement a separate area, cost was cited as a barrier to implementation.

Seven of the 14 Health Boards reported that they do not have an area to carry out complication /investigative scans separated from women with a continuing pregnancy either within or out with the EPU. NHS Borders have plans to implement this in the next two years, one site in NHS Lothian plan to implement this in the next two years, while NHS Fife, NHS Highland, NHS Orkney, NHS Shetland and NHS Western Isles have no plans to implement this service.