Miscarriage Care and Facilities in Scotland: Scoping Report NHS Borders

Management options

In NHS Borders, Borders General Hospital agreed that women are free to choose their preferred management approach based on their needs and preferences. They strongly disagreed that women are offered only the management approaches provided on this site, and strongly disagreed that women may be referred to another site depending on the management approach they choose.

In NHS Borders, all management options for miscarriage care are offered at Borders General Hospital. All options were provided for first trimester losses. Medical management with misoprostol or with misoprostol and mifepristone as an inpatient is offered in the second trimester.

All sites were asked to fully describe the treatment pathway for expectant management, medical management and surgical management. The descriptions provided have been presented under the relevant subheadings below; these narratives contain only information provided by the sites during this exercise. For all management options at Borders General Hospital, scans are provided in the EPU to confirm loss.

Expectant management in NHS Borders

Once expectant management is decided upon as the preferred option, women are advised about expectant management risks and benefits and are provided with written information. The patient is given contact numbers and a follow-up is arranged after one week. The patient is made aware that they can change their mind at any time.

Medical management at NHS Borders

Medical management is provided at Borders General Hospital. Medical management with misoprostol and medical management with mifepristone and misoprostol are both offered in the first and second trimesters. Medical management is also offered as either an in-patient or out-patient service, however, treatment as an out-patient is only offered to those in the first trimester.

The treatment pathway for medical management described by Borders General Hospital states that women are given written information about the process and are asked to give consent. Where a women is treated as an out-patient she is advised to have another adult at home for safety as well as emotional support. The patient is given mifepristone in the department and they are provided with misoprostol and analgesia to take home. At home, the patient is advised when to take the misoprostol, if there is no bleeding after 4 hours they are advised to take the remaining two tablets. Women are advised to contact EPU if bleeding does not start within 24 hours or if bleeding remains heavy or they feel dizzy or faint. Soon after the treatment, the patient will be contacted and advised if any further follow-up is required. They are also advised to take a pregnancy test three weeks after the treatment and to contact EPU if this is still positive.

Surgical management at NHS Borders

In Borders General Hospital surgical management with manual vacuum aspiration (MVA) with local anaesthetic and surgical management under general anaesthetic are offered in the first trimester only.

The treatment pathway for surgical management described by Borders General Hospital states that patients are given written information on the procedure and to give consent. They are then admitted on the morning of the procedure and are usually first on the theatre list. Once the procedure is complete the woman is cared for in the bereavement room and depending on gestation and the women's wishes, follow-up ranges from consultant review to no further follow-up.