Miscarriage Care and Facilities in Scotland: Scoping Report NHS Dumfries and Galloway

Opening hours of miscarriage care services

Early Pregnancy Units

The Lancet series on Miscarriage Matters recommended that healthcare funders and providers 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.

17 of the 44 sites reported that they have a dedicated Early Pregnancy Unit (EPU). This was across 10 Health Board areas (Table 2).

NHS Dumfries and Galloway reported that neither of the two sites provide a dedicated EPU, however, early pregnancy services are available within existing structures at Dumfries and Galloway Royal Infirmary (Table 6).

Maternity Units

19 sites of the 44 sites reported that they have a Maternity Unit that is currently open. This was across all 14 Health Board areas.

NHS Dumfries and Galloway reported that there is a Maternity Unit at Dumfries and Galloway Royal Infirmary which is open 24 hours a day seven days a week (Table 7).

Community Maternity Units

21 of the 44 sites said that they have a Community Maternity Unit (CMU). This was across 7 Health Board areas. The Best Start: A five year plan for Maternity and Neonatal Care refers to CMUs as either being freestanding units or alongside units.

NHS Dumfries and Galloway reported that there are no Community Maternity Unit in either of the two sites in NHS Dumfries and Galloway. However, Galloway Community Hospital operates a Community Midwifery Hub which is open 09:00-17:00 7 days a week for antenatal and postnatal appointments only (Table 8).

*There is no operational CMU at Galloway Community Hospital

Obstetrics and Gynaecology

21 of the 44 sites said they had an Obstetrics and Gynaecology department. This was across all 14 Health Boards areas.

NHS Dumfries and Galloway reported that there is an Obstetrics and Gynaecology Department at Dumfries and Galloway Royal Infirmary which is open 24 hours a day seven days a week (Table 9).

Recurrent miscarriage services

13 of the 44 sites said they have recurrent miscarriage services. This was across 11 Health Board areas.

NHS Dumfries and Galloway reported that a recurrent miscarriage clinic (RMC) is operated from Dumfries and Galloway Royal Infirmary which is available one day a week on Mondays 9:00-12:30. This service is closed on all other days of the week (Table 10).

Infertility services

14 of the 44 sites said they have infertility services. This was across 12 Health Board areas.

NHS Dumfries and Galloway reported that infertility services run at both sites. At Dumfries and Galloway Royal Infirmary, infertility services are available 8:00-14:00 Monday to Wednesday and are closed on all other days of the week. Infertility services are also available at Galloway Community Hospital approximately one Wednesday every three months between 9:00-17:00 (Table 11).

Accident and Emergency

37 of the 44 sites said they have a Accident and Emergency (A&E) department. This was across all 14 Health Board areas. All A&E sites said they were open 24 hours every day including weekends in all Health Board areas.

In Dumfries and Galloway both sites have an A&E facility that is open 24 hours a day, seven days a week.

Out of Hours Care

If a woman presents at A&E with suspected miscarriage through the night (out of hours) in Scotland the reported processes varied both within and between Health Boards.

Sites were asked what would happen if a woman presents at A&E with suspected miscarriage through the night (out of hours) within NHS Dumfries and Galloway. Galloway Community Hospital reported that if a woman presents at A&E with suspected miscarriage through the night (out of hours) at their site, they are transferred to Dumfries and Galloway Royal Infirmary as Galloway Community Hospital A&E department does not have an onsite gynaecology team.

If a woman presented at Galloway Community Hospital through the night (out of hours) the medical staff in A&E would make an initial airway, breathing, circulation assessment (ABC assessment). If a woman’s symptoms are mild and stable and suitable for discharge home, this is arranged with follow up appointments with the local midwifery team or the Early Pregnancy Services the next working day. If a woman was actively miscarrying but remained unstable, medical staff will contact the on call gynaecology team at Dumfries and Galloway Royal Infirmary for advice and the patient would remain in A&E for observation and completion of miscarriage until stable and suitable for discharge home. Again, follow up would be arranged with Early Pregnancy Services. In an emergency situation, medical staff would initiate an ABC assessment and arrange for an emergency transfer to Dumfries and Galloway Royal Infirmary.

Out of hours care at Dumfries and Galloway Royal Infirmary is dependent on the initial assessment, with referral to obstetrics and gynaecology team. Women may be triaged and sent home if stable, with referrals to Early Pregnancy Services for follow up during working hours.