Miscarriage Care and Facilities in Scotland: Scoping Report NHS Grampian

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 Grampian reported that the Early Pregnancy Unit (EPU) at Aberdeen Maternity Hospital is open 07:00-21:00 seven days a week with emergency access and specialist staff available 24 hours a day. At Dr. Gray’s Hospital, the EPU is open 08:30-16:30 Monday to Friday and closed at the weekends. If women present at the other four sites with a miscarriage they would be directed to Aberdeen Maternity Hospital (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 Grampian reported that the maternity units at Aberdeen Maternity Hospital and Dr. Gray’s Hospital are both 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 Grampian reported that there are three community maternity units at Aberdeen Maternity Hospital, Peterhead Community Hospital and Inverurie Health & Care Hub. These are all open 24 hours per day seven days a week (Table 8).

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 Grampian reported that there are two Obstetrics and Gynaecology departments at Aberdeen Maternity Hospital and Dr. Gray’s Hospital. The Obstetrics and Gynaecology department is open 24 hours a day seven days a week at Aberdeen Maternity Hospital, at Dr. Gray’s Hospital the Obstetrics and Gynaecology department 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 Grampian reported that the recurrent miscarriage services are operated from Aberdeen Maternity Hospital. Two consultant clinics are run per month on the first and third Mondays of each month. Aberdeen Maternity Hospital also runs a nurse/midwifery led clinic for women after a second miscarriage every Monday. Women referred to the recurrent miscarriage clinic also have access to EPU telephone advice 24 hours a day (Table 10).

Infertility services

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

NHS Grampian reported that infertility services run Monday to Friday 08:00-16:00 with telephone advice from 16:00-08:00 and 24 hour telephone advice on Saturdays and Sunday at Aberdeen Maternity Hospital (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 NHS Grampian four sites reported that they have an accident and emergency facility which is open 24 hours seven days a week: Aberdeen Maternity Hospital, Dr. Gray’s Hospital, Jubilee Hospital and Fraserburgh Hospital. There are no A&E facilities at Peterhead Community Hospital or Inverurie Health and Care Hub.

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.

If a woman presents at A&E at Fraserburgh Hospital or Jubilee Hospital with suspected miscarriage through the night (out of hours) within NHS Grampian they are referred or transferred to Aberdeen Maternity Hospital. If presenting at Aberdeen Maternity Hospital they are referred to the EPU. If a situation arose with a woman miscarrying in the emergency department at Aberdeen Maternity Hospital, the EPU staff, midwife and obstetrics and gynaecology staff would go to the emergency department. If a women presents at Dr. Gray’s Hospital out of hours, a speculum examination would be carried out and the on call obstetrician or a member of staff from the maternity ward would be contacted for advice regarding ongoing care.