Miscarriage Care and Facilities in Scotland: Scoping Report NHS Borders

PfG

The Lancet: Miscarriage Matters

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

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

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

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

Patient support groups

Online self-help strategies for mental health

Weight management

Smoking and recreational drugs cessation services

Information on appropriate preconceptual folate and vitamin D supplementation

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

Screening for mental health issues.

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

Continuity of Care

Tests for full blood count are offered

Tests for thyroid function are offered

Discussion about lifestyle issues

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

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

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.

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

Blood tests for antiphospholipid antibodies will be arranged.

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

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.

Appropriate screening for mental health issues.

Appropriate care for mental health issues.

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

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.

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

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.

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.

Identifying women at risk of psychological distress following miscarriage.

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

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.

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

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

The Lancet: Miscarriage Matters

Research Recommendations