Publication - Research and analysis

Miscarriage Care and Facilities in Scotland: Scoping Report NHS Fife

Published: 29 November 2023
From: Director-General Education and Justice
Directorate: Children and Families Directorate
ISBN: 9781835215289

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

Supporting documents

Summary

The overall summary 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 Fife, Victoria Hospital is the core site that provides care for women that experience miscarriage.

In NHS Fife, Victoria Hospital provides written information about the treatment options for the management of miscarriage and what to expect next in terms of miscarriage.

In NHS Fife women are provided with full explanations about what would 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 Fife a graded approach to treatment of recurrent miscarriage is provided at Victoria Hospital. All elements outlined in the Lancet Series on Miscarriage Matters are provided in NHS Fife.

Dedicated facilities for women experiencing unexpected pregnancy complications at any gestation are available at Victoria Hospital, where three separate rooms are available on the gynaecology ward.

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

In NHS Fife data on miscarriage is collected via Trakcare and BadgerNet EPAGU and through face to face appointments. Data is collected on the number of miscarriages, gestation, maternal age, parity, SIMD and ethnicity. In NHS Fife data is also collected on religion and partner status. There is currently no data collected on miscarriages as a proportion of pregnancies.

Table 25: Scottish Government Programme for Government (PfG) Commitments and the Lancet Miscarriage Matters Recommendations
Source	Commitment/Recommendation	Service provision in NHS Fife
PfG	Ensure women's services in Health Boards have dedicated facilities for women who are experiencing unexpected pregnancy complications.	NHS Fife had dedicated provision for women experiencing unexpected pregnancy complications at Victoria Hospital. These facilities were provided in the early pregnancy unit (EPU) and outwith the EPU. Victoria Hospital has 9 rooms on the gynaecology ward.
The Lancet: Miscarriage Matters	A graded approach to the treatment of recurrent miscarriage	In NHS Fife a graded approach to treatment of recurrent miscarriage is provided at Victoria Hospital
After first miscarriage
After the first miscarriage, women will be guided to information about miscarriage		Provided at Victoria Hospital.
After the first miscarriage, women will be guided to resources to address their physical needs		Provided at Victoria Hospital
After the first miscarriage, women will be guided to resources to address mental health needs following pregnancy loss		Provided at Victoria Hospital
After the first miscarriage, women will be guided to ways to optimise their health for future pregnancy		Provided at Victoria Hospital
After first miscarriage - this approach could involve:
Patient support groups		Provided at Victoria Hospital
Online self-help strategies for mental health		Provided at Victoria Hospital
Weight management		Provided at Victoria Hospital
Smoking and recreational drugs cessation services		Provided at Victoria Hospital
Information on appropriate preconceptual folate and vitamin D supplementation		Provided at Victoria Hospital
Referral to necessary services for management and optimisation of chronic maternal medical conditions (e.g., diabetes, hypertension, heart disease, and epilepsy)		Provided at Victoria Hospital
Screening for mental health issues.		Provided at Victoria Hospital
After second miscarriage
Women will be offered an appointment at a miscarriage clinic nurse or midwifery-led		Provided at Victoria Hospital
Continuity of Care		Provided at Victoria Hospital
Tests for full blood count are offered		Provided at Victoria Hospital
Tests for thyroid function are offered		Provided at Victoria Hospital
Discussion about lifestyle issues		Provided at Victoria 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 Victoria Hospital
Women will have access to support and early pregnancy reassurance scans in subsequent pregnancies.		Provided at Victoria 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 Victoria Hospital
Pregnancy tissue from the third and any subsequent miscarriages will be sent for genetic testing.		Provided at Victoria Hospital
Blood tests for antiphospholipid antibodies will be arranged.		Provided at Victoria Hospital
A pelvic ultrasound scan (ideally three dimensional transvaginal) will be arranged		Provided at Victoria 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 Victoria Hospital
Appropriate screening for mental health issues		Provided at Victoria Hospital
Appropriate care for mental health issues		Provided at Victoria Hospital
Overall recommendations
Appropriate screening and care for future obstetric risks, particularly preterm birth, fetal growth restriction, and stillbirth.		Provided at Victoria 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 Victoria Hospital
Consider giving vaginal micronised progesterone in women with early pregnancy bleeding and a history of miscarriage		Provided at Victoria Hospital
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.		Victoria Hospital has midwives/nurses and doctors with additional specialist training to provide comprehensive miscarriage care as week as specialized medical staff trained specifically for recurrent 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		Victoria Hospital provides expectant management options as well as medical management with misoprostol and surgical management under general anaesthetic. They do not provide medical management with mifepristone and misoprostol or surgical management with manual vacuum aspiration with local anaesthetic.
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.		Data on miscarriage is collected via BadgerNet (EPAGU) and Trakcare. Data is collected on the number of miscarriages, gestation, maternal age, parity, SIMD and ethnicity. In NHS Fife data is also collected on religion and partner status. There is currently no data collected on miscarriages as a proportion of pregnancies.
Identifying women at risk of psychological distress following miscarriage		Provided at Victoria 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 Victoria 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 Victoria 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		Victoria Hospital reported that women are free to choose the management approach that suits their needs.
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, Public Health Scotland and Maternity and Children Quality Improvement Collaborative (MCQIC)
	Key epidemiological research priority 2 - Ascertaining if miscarriage risk and prevalence differ across nations and ethnic groups.	Project underway with Scottish Government, Public Health Scotland and Maternity and Children Quality Improvement Collaborative (MCQIC)
	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.	Project underway with Scottish Government, Public Health Scotland and Maternity and Children Quality Improvement Collaborative (MCQIC)
	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	Project underway with Scottish Government, Public Health Scotland and Maternity and Children Quality Improvement Collaborative (MCQIC)

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Email: socialresearch@gov.scot

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