Miscarriage Care and Facilities in Scotland: Scoping Report NHS Forth Valley
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 are presented below and are shown in Table 25 alongside the recommendations within the Lancet series on Miscarriage Matters and the Scottish Government Programme for Government commitments.
In NHS Forth Valley, Forth Valley Royal Hospital is the core site that provides care for those that experience miscarriage.
In NHS Forth Valley, Forth Valley Royal Hospital provides written information about the treatment options for the management of miscarriage, what to expect in terms of miscarriage care and information on what would happen before, during and after any treatment.
In NHS Forth Valley, women are provided with full explanations about what would happen during their chosen method of management, after the 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 Forth Valley, a graded approach to treatment of recurrent miscarriage is provided at Forth Valley Royal Hospital. All elements outlined in the Lancet series on Miscarriage Matters are provided in NHS Forth Valley with the exception of medical management with misoprostol.
Dedicated facilities for women experiencing unexpected pregnancy complications at any gestation are available at Forth Valley Royal Hospital, where three rooms are available (gynaecology ward, quiet rooms in ultrasound scanning, bereavement room in maternity unit.
In Forth Valley Royal Hospital there is a separate area to carry out complicated/investigative scans separated from area for women with a continuing pregnancy.
In NHS Forth Valley data on miscarriage is collected via BadgerNet. Data is collected on the number of miscarriages as a proportion of pregnancies, gestation and maternal age. There is currently no data collected on SIMD, parity or ethnicity. This data is then presented at local unit meetings for review. In NHS Forth Valley, all pregnancies are recorded as a miscarriage including biochemical pregnancies.
| Source | Commitment/Recommendation | Service Provision in NHS Forth Valley |
|---|---|---|
| PfG | Ensure women's services in Health Boards have dedicated facilities for women who are experiencing unexpected pregnancy complications | In NHS Forth Valley there is dedicated provision for women experiencing unexpected pregnancy complications at Forth Valley Royal Hospital; these facilities were provided in the early pregnancy unit and outwith the EPU. Forth Valley Royal Hospital has 3 rooms (gynaecology ward, quiet rooms in USS, bereavement room in maternity unit). |
| The Lancet: Miscarriage Matters | A graded approach to the treatment of recurrent miscarriage | In NHS Forth Valley a graded approach to treatment of recurrent miscarriage care is not provided at Forth Valley Royal Hospital due to staff training and financial reasons, with no current plans to implement. |
| After first miscarriage | ||
| After the first miscarriage, women will be guided to information about miscarriage | Provided at Forth Valley Royal Hospital | |
| After the first miscarriage, women will be guided to resources to address their physical needs | Provided at Forth Valley Royal Hospital | |
| After the first miscarriage, women will be guided to resources to address mental health needs following pregnancy loss | Provided at Forth Valley Royal Hospital | |
| After the first miscarriage, women will be guided to ways to optimise their health for future pregnancy | Provided at Forth Valley Royal Hospital | |
| After first miscarriage - this approach could involve: | ||
| Patient support groups | Provided at Forth Valley Royal Hospital | |
| Online self-help strategies for mental health | Not provided in NHS Forth Valley | |
| Weight management | Not provided in NHS Forth Valley | |
| Smoking and recreational drugs cessation services | Not provided in NHS Forth Valley | |
| Information on appropriate preconceptual folate and vitamin D supplementation | Provided at Forth Valley Royal Hospital | |
| Referral to necessary services for management and optimisation of chronic maternal medical conditions (e.g., diabetes, hypertension, heart disease, and epilepsy) | Provided at Forth Valley Royal Hospital. | |
| Screening for mental health issues. | Not provided in NHS Forth Valley | |
| After second miscarriage | ||
| Women will be offered an appointment at a miscarriage clinic nurse or midwifery-led | Not provided in NHS Forth Valley | |
| Continuity of Care | Not provided in NHS Forth Valley | |
| Tests for full blood count are offered | Not provided in NHS Forth Valley | |
| Tests for thyroid function are offered | Not provided in NHS Forth Valley | |
| Discussion about lifestyle issues | Provided within information leaflet | |
| Referral for specialist care will be arranged if tests are abnormal or if there is a chronic medical or mental health problem. | Provided at Forth Valley Royal Hospital | |
| Women will have access to support and early pregnancy reassurance scans in subsequent pregnancies. | Provided at Forth Valley Royal 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 Forth Valley Royal Hospital | |
| Pregnancy tissue from the third and any subsequent miscarriages will be sent for genetic testing. | Provided at Forth Valley Royal Hospital | |
| Blood tests for antiphospholipid antibodies will be arranged. | Provided at Forth Valley Royal Hospital | |
| A pelvic ultrasound scan (ideally three dimensional transvaginal) will be arranged | Provided at Forth Valley Royal 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 Forth Valley Royal Hospital | |
| Appropriate screening for mental health issues | Not provided in NHS Forth Valley | |
| Appropriate care for mental health issues | Provided at Forth Valley Royal Hospital | |
| Overall recommendations | ||
| Appropriate screening and care for future obstetric risks, particularly preterm birth, fetal growth restriction, and stillbirth. | Provided at Forth Valley Royal 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 Forth Valley Royal Hospital | |
| Consider giving vaginal micronised progesterone in women with early pregnancy bleeding and a history of miscarriage | Provided at Forth Valley Royal 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. | Forth Valley Royal Hospital has midwives/nurses and staff with additional specialist training to provide comprehensive miscarriage care and to deal with all baby losses from early pregnancy to stillbirth. | |
| 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 | Forth Valley Royal Hospital carry out scans in the EPU and outwith EPU Management options with mifepristone and misoprostol are available at Forth Valley Royal Hospital, as well as 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. | Data on miscarriage is collected via BadgerNet for Forth Valley Royal Hospital. Data is collected on the number of miscarriages, miscarriages as a proportion of pregnancies, gestation and maternal age. There is currently no data collected on parity, SIMD and ethnicity. Data on miscarriage is presented at local unit meetings for review. | |
| Identifying women at risk of psychological distress following miscarriage | Patients in NHS Forth Valley are signposted to other services for assessment of 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. | Not assessed | |
| 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 Forth Valley Royal 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 | Forth Valley Royal Hospital said 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. | 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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