Miscarriage Care and Facilities in Scotland: Scoping Report NHS Borders

This report details the findings of a scoping exercise to better understand miscarriage care in Scotland within this Health Board. The individual Health Board reports and the national report seek to aid policy makers and Health Boards in making decisions about improvements to Miscarriage Care


Summary

A summary of findings is presented below and is shown in Table 25 against the recommendations within the Lancet series on Miscarriage Matters and the Scottish Government Programme for Government commitments.

In NHS Borders, Borders General Hospital provides care for those that experience miscarriage where women are free to choose the management approach that suits their needs.

In NHS Borders, Borders General Hospital provides written information about the treatment options for the management of miscarriage and what to expect in terms of miscarriage care or information on what would happen before, during, and after any treatment options.

Within NHS Borders, women are provided with full explanations about what will happen during their chosen method of management, after the chosen method of management and in terms of follow-up. Women are free to choose their preferred management approach based on their needs and preferences.

In NHS Borders, a graded approach to treatment of recurrent miscarriage is provided at Borders General Hospital, where all patients within the Health Board area are treated for miscarriage. All elements outlined in the Lancet series on Miscarriage Matters are provided in NHS Borders at Borders General Hospital, with the exception of tests for thyroid function and vaginal micronised progesterone in women with early pregnancy bleeding and a history of miscarriage after a first miscarriage.

Dedicated facilities for women experiencing unexpected pregnancy complications at any gestation are available at Borders General Hospital.

In NHS Borders, Borders General Hospital does not have a separate area to carry out complication/investigative scans separated from women with a continuing pregnancy.

In NHS Borders no data on miscarriage is currently collected.

Table 25: Scottish Government Programme for Government (PfG) Commitments and the Lancet Miscarriage Matters Recommendations

Source

Commitment/

Recommendation

Service provision in NHS Borders

PfG

Ensure women's services in Health Boards have dedicated facilities for women who are experiencing unexpected pregnancy complications.

Dedicated facilities are provided.

No dedicated rooms are available although there is a bereavement room available attached to labour ward

The Lancet: Miscarriage Matters

A graded approach to the treatment of recurrent miscarriage.

In NHS Borders a graded approach to treatment of recurrent miscarriage is provided at Borders General Hospital

After First Miscarriage

After the first miscarriage, women will be guided to information about miscarriage

Provided at Borders General Hospital

After the first miscarriage, women will be guided to resources to address their physical needs

Provided at Borders General Hospital

After the first miscarriage, women will be guided to resources to address mental health needs following pregnancy loss

Provided at Borders General Hospital

After the first miscarriage, women will be guided to ways to optimise their health for future pregnancy

Provided at Borders General Hospital

After First Miscarriage - this approach could involve:

Patient support groups

Provided at Borders General Hospital

Online self-help strategies for mental health

Provided at Borders General Hospital

Weight management

Provided at Borders General Hospital

Smoking and recreational drugs cessation services

Provided at Borders General Hospital

Information on appropriate preconceptual folate and vitamin D supplementation

Provided at Borders General Hospital

Referral to necessary services for management and optimisation of chronic maternal medical conditions (e.g., diabetes, hypertension, heart disease, and epilepsy)

Provided at Borders General Hospital

Screening for mental health issues.

Provided at Borders General Hospital

After Second Miscarriage

Women will be offered an appointment at a miscarriage clinic nurse or midwifery-led

Not currently provided – would be referred to consultant-led clinic at Borders General Hospital

Continuity of Care

Provided at Borders General Hospital

Tests for full blood count are offered

Provided at Borders General Hospital (after first miscarriage also)

Tests for thyroid function are offered

Not currently provided – no plans to implement at Borders General Hospital

Discussion about lifestyle issues

Provided at Borders General Hospital

Referral for specialist care will be arranged if tests are abnormal or if there is a chronic medical or mental health problem.

Provided at Borders General Hospital

Women will have access to support and early pregnancy reassurance scans in subsequent pregnancies.

Provided at Borders General Hospital

After Third and Subsequent Miscarriage

Women will be offered an appointment at a medical consultant-led clinic, in which additional tests and a full range of treatments can be offered.

Provided at Borders General Hospital

Pregnancy tissue from the third and any subsequent miscarriages will be sent for genetic testing.

Provided at Borders General Hospital

Blood tests for antiphospholipid antibodies will be arranged.

Provided at Borders General Hospital

A pelvic ultrasound scan (ideally three dimensional transvaginal) will be arranged.

Provided at Borders General Hospital

If necessary, parental karyotyping will be offered depending on the clinical history and the results of the genetic analysis of pregnancy tissue from previous losses.

Provided at Borders General Hospital

Appropriate screening for mental health issues.

Provided at Borders General Hospital

Appropriate care for mental health issues.

Provided at Borders General Hospital

Overall Recommendations

Appropriate screening and care for future obstetric risks, particularly preterm birth, fetal growth restriction, and stillbirth.

Provided at Borders General Hospital

Appropriate screening and care for future obstetric risks and mental health issues will need to be incorporated into the care pathway for couples with a history of recurrent miscarriage.

Provided at Borders General Hospital

Consider giving vaginal micronised progesterone in women with early pregnancy bleeding and a history of miscarriage.

Provided at Borders General Hospital after second or third miscarriage - not first miscarriage.

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.

Borders General Hospital has midwives/nurses with additional specialist training to provide comprehensive miscarriage care. Borders General Hospital also has doctors trained to provide comprehensive miscarriage care.

Early pregnancy services need to focus on providing an effective ultrasound service, as it is central to the diagnosis of miscarriage, and be able to provide expectant management of miscarriage, medical management with mifepristone and misoprostol, and surgical management with manual vacuum aspiration.

Borders General Hospital is able to carry out scans in the EPU.

In NHS Borders, Borders General Hospital provides expectant management, medial management with mifepristone and misoprostol and surgical management with manual vacuum aspiration on site.

Recommend that miscarriage data are gathered and reported to facilitate comparison of rates among countries, to accelerate research, and to improve patient care and policy development. We recommend that every country reports annual aggregate miscarriage data, similarly to the reporting of stillbirth.

No data is currently collected on miscarriage in NHS Borders.

Identifying women at risk of psychological distress following miscarriage.

Provided at Borders General Hospital.

Identifying women at risk of psychological distress following miscarriage and the development of optimal treatment strategies have been recognised as research priorities.

Provided at Borders General Hospital.

Women with a history of miscarriage, particularly those with three or more miscarriages, are at an increased risk of obstetric complications including preterm birth. Therefore, these women should be treated as patients at high risk during antenatal and intrapartum care.

Provided at Borders General Hospital.

Miscarriage Management - women should be presented with the available evidence and be free to choose the management approach that suits their needs and preferences.

Borders General Hospital said that women are free to choose the management approach based on their needs and preferences.

Consider pathways of care for miscarriage management, treatment of women with a history of miscarriage and care following a miscarriage.

Not assessed.

The Lancet: Miscarriage Matters

Research Recommendations

Key epidemiological research priority 1 - Establishing how we can monitor miscarriage rates on a population basis.

Project underway with Scottish Government and Public Health Scotland

Key epidemiological research priority 2 - Ascertaining if miscarriage risk and prevalence differ across nations and ethnic groups.

Project underway with Scottish Government and Public Health Scotland

Key epidemiological research priority 3 - Whether miscarriage rate is increasing, and if so why; what the key outcomes are from women's point of view.

Work to follow from research priorities 1 and 2 above.

Key epidemiological research priority 4 - Which risk factors for miscarriage are potentially causative and modifiable; and the effect of modification of the risk factor on clinical outcomes

Work to follow from research priorities 1 and 2 above.

Contact

Email: socialresearch@gov.scot

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