Miscarriage Care and Facilities in Scotland: Scoping Report NHS Highland

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 Highland reported that there is one EPU at Raigmore Hospital. The opening times of the EPU is 08:30-15:30 four days a week and it is closed on Wednesday, Saturdays and Sundays (Table 6).

*Closed on Wednesday

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 Highland reported that there is one maternity unit in NHS Highland at Raigmore Hospital and that the unit is 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 Highland reported that there are eight CMU. At both Dr MacKinnon Memorial Hospital and Caithness General Hospital the CMU are open 09:00-17:00 seven days a week. At Belford Hospital, the CMU is open 08:00-17:00 seven days a week. In Argyll and Bute Campbeltown Hospital, Cowal Community Hospital, Lorn & Islands Hospital, Mid Argyll Community Hospital, and Victoria Hospital run a CMU which are all open seven days a week 08:00-18:00, with on-call cover outwith these hours (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 Highland reported that there is one Obstetrics and Gynaecology department at Raigmore Hospital which is open 24 hours a day seven days a week (Table 9). For sites in Argyll and Bute, women are referred to NHS Greater Glasgow and Clyde.

Recurrent miscarriage services

13 of the 44 sites said they have recurrent miscarriage services. This was across 11 Health Board areas.

NHS Highland reported that recurrent miscarriage services operate at Raigmore Hospital with daily appointments with a nurse specialist. Raigmore Hospital also provides one consultant led recurrent miscarriage clinic a month (Table 10).

Infertility services

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

There are no infertility services available at any of the sites in NHS Highland. Women are referred to Aberdeen Maternity Hospital in NHS Grampian or NHS Greater Glasgow and Clyde for those in Argyll and Bute.

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.

All sites in NHS Highland that have an A&E department, reported that their A&E department is open 24 hours a day seven days a week. Nairn town and County Hospital and Belford Hospital do not have A&E departments.

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.

All sites in NHS Highland were asked what would happen if a woman presents at A&E with suspected miscarriage through the night (out of hours). Raigmore Hospital reported that women who present at their site would first be assessed by the A&E doctor, with bloods taken for quantitative human chorionic gonadotropin (QHCG – pregnancy hormone) if in early pregnancy. Details would then be discussed with the on call obstetrics and gynaecology registrar regarding the need for immediate assessment or admission. If necessary, women would be assessed and examined on a ward by the on-call team (there are no out of hours scanning facilities within this department). A referral would be made to the EPU where they would be telephoned and assessed the following working day and a scan appointment made if required.

Dr. MacKinnon Memorial Hospital reported that if a woman presents at their site out of hours, the care will depend on the woman’s condition. If suffering from heavy bleeding, they would be treated on site and possibly transferred to Raigmore Hospital when stable. Similarly, Belford Hospital reported that if a woman presents at A&E at their site, they would be medically assessed by the on call doctor for haemodynamic stability and transferred to Raigmore Hospital or, if suitable, discharged home with their GP informed. Caithness General Hospital reported that women would either be transferred to Raigmore Hospital or asked to attend for ultrasound scan locally during opening hours. Nairn Town and County Hospital does not have an A&E department at which women would present. At sites in Argyll and Bute, the Obstetrics and Gynaecology team would be contacted in NHS Greater Glasgow and Clyde for advice.