Miscarriage Care and Facilities in Scotland: Scoping Report NHS Grampian

Dedicated Facilities

Unexpected Pregnancy Complications

The Scottish Government has committed to the provision of dedicated facilities for women experiencing unexpected pregnancy complications through the Programme for Government 2021-22^[6]. All sites were asked if they currently provide dedicated facilities for women experiencing unexpected pregnancy complications at any gestation. Sites with an EPU were also asked to indicate if they currently provide dedicated facilities for women experiencing unexpected pregnancy complications at any gestation within the EPU.

Within NHS Grampian, Dr. Gray’s Hospital indicated that they currently provide dedicated facilities for women experiencing unexpected pregnancy complications at any gestation both within and outwith the EPU. Aberdeen Maternity Hospital indicated that they currently provide dedicated facilities for women experiencing unexpected pregnancy complications within the EPU with no plans to implement this outwith the EPU (Table 12).

Women that present at Peterhead Community Hospital and Inverurie Health & Care Hub are referred to Aberdeen Maternity Hospital for miscarriage management.

Fraserburgh Hospital and Jubilee Hospital were not asked these questions as service provision is at Aberdeen Maternity Hospital.

Separate room/area/ward

All sites in Scotland were asked if they provide a separate room, area, or ward away from the labour ward for women that are miscarrying. They were also asked if they provide a separate room, area, ward or unit with dedicated services to admit women who are miscarrying. The number of separate rooms reported to be available for women who are experiencing miscarriage ranged between 1 and 12 rooms per site in Scotland.

In NHS Grampian, Aberdeen Maternity Hospital and Dr. Gray’s Hospital have an EPU. At Aberdeen Maternity Hospital, the EPU provides face to face reviews for all clinical complaints in relation to pregnancy, including miscarriage, up to 23 weeks and 6 days gestation. This site provides all inpatient and outpatient care for miscarriage, all diagnostic and medical management for ectopic pregnancies, medical and surgical management for molar pregnancies and second trimester miscarriage and all hyperemesis outpatient ambulatory management. Aberdeen Maternity Hospital reported that they can provide separate room/area/ward for women who are miscarrying within the EPU and Dr. Gray’s Hospital can provide this both within and outwith the EPU. Aberdeen Maternity Hospital reported that they have seven rooms within the Rubislaw ward which is the EPU and a bereavement suite with combined clinical area. At Aberdeen Maternity Hospital these spaces are also available for use for women experiencing still births, termination of pregnancy due to fetal anomaly (TOPFA), ectopic and molar pregnancies. Dr. Gray’s Hospital reported that they have one room dedicated for pregnancy loss and access to another which is not solely dedicated for pregnancy loss. At Dr Gray’s Hospital these spaces are also available for ectopic and molar pregnancies, women are transferred to Aberdeen Maternity Hospital for stillbirth and TOPFA (Table 12).

Scanning facilities

Scans are often performed to confirm a miscarriage has occurred. For this scoping exercise all sites were asked if a separate area was available to carry out complication or investigative scans separated from women with a continuing pregnancy.

Overall, 7 out of the 14 Health Boards reported having a separate area to carry out complication/investigative scans separated from women with a continuing pregnancy, either within or outwith the EPU.

When asked about areas where complication or investigative scans are carried out in NHS Grampian, scans are conducted in the Early Pregnancy Unit at Aberdeen Maternity Hospital and are conducted in an area away from women with a continuing pregnancy.

Within the EPU at Dr Gray’s Hospital early pregnancy scanning, beta human chorionic gonadotropin (BHCG) blood tests, dating scans, detailed scans and left ventricle/growth/doppler scans are provided and these are conducted in the same area as women with a continuing pregnancy (Table 13). If a woman presents in the A&E department at Aberdeen Maternity Hospital and is not able to be transferred to the EPU, a transabdominal scan would be possible with and emergency department scanner and if a transvaginal scan was needed a scan machine could be brought to the emergency department from the gynaecology ward/clinic.

Women that present at Peterhead Community Hospital and Inverurie Health & Care Hub are referred to Aberdeen Maternity Hospital for miscarriage management.

Fraserburgh Hospital and Jubilee Hospital were not asked these questions as service provision is at Aberdeen Maternity Hospital.