Miscarriage Care and Facilities in Scotland: Scoping Report NHS Greater Glasgow and Clyde

Dedicated Facilities

Unexpected pregnancy complications at any gestation

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.

In NHS Greater Glasgow and Clyde, all sites indicated that they currently provide dedicated facilities for women experiencing unexpected pregnancy complications at any gestation. Inverclyde Royal Hospital currently provide this within the EPU, Queen Elizabeth University Hospital reported that when provided outwith the EPU, only women in the first trimester would be seen in a separate area as those in the second trimester would be assessed via maternity triage where other pregnant women are also assessed (Table 12).

* If gestation < 16 weeks separate area in EPU. If > 16 weeks maternity triage therefore not separated from other women with a continuing pregnancy.

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 Greater Glasgow and Clyde, Royal Alexandra Hospital and Princess Royal Maternity Hospital reported that they provide a separate room/area/ward for women who are miscarrying and also have a separate room area/ward/unit with dedicated services to admit women who are miscarrying. In Royal Alexandra Hospital there are three separate rooms within the gynaecology ward and in Princess Royal Maternity Hospital there is one room within the EPU, one in day care and one in the gynaecology ward. The Queen Elizabeth University Hospital reported that they currently do not have a separate room/area/ward for women who are miscarrying or a separate room area/ward/unit with dedicated services to admit women who are miscarrying within the EPU but there are plans to implement this in the next two years. However, Queen Elizabeth University Hospital are currently able to provide this outwith the EPU for women who are less than 16 weeks gestation and miscarrying. Those who are over 16 weeks gestation are assessed via maternity triage and therefore are not away from other women with a continuing pregnancy. It is noted that some rooms/areas are not solely used for miscarriage care and may be used for other pregnancy complications or loss including termination of pregnancy due to fetal anomaly (TOPFA), ectopic pregnancies and molar pregnancies. The facilities that are provided are set out in Table 12 above.

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 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.

In NHS Greater Glasgow and Clyde, Queen Elizabeth University Hospital, Vale of Leven District General Hospital and Princess Royal Maternity Hospital reported that scans are conducted in their EPU during opening hours in an area separate from other expectant mothers. Royal Alexandra Hospital and Inverclyde Royal Hospital are able to offer scans at their EPU, but these are conducted in the same area as other expectant mothers.

NHS Greater Glasgow and Clyde also has the facilities to conduct scans within the Obstetrics and Gynaecology departments at Royal Alexandra Hospital, Queen Elizabeth Hospital and Princess Royal Maternity Hospital 24 hours a day, seven days a week when staff with the appropriate skills are present. When a woman presents out of hours and is not in a stable condition an investigative scan would immediately take place at these hospitals by an appropriately qualified member of medical staff. Only the Obstetrics and Gynaecology department at the Royal Alexandra Hospital is able to conduct these scans in an area separate from other expectant mothers. No scans to confirm a miscarriage are conducted at A&E departments across all five sites.