Miscarriage Care and Facilities in Scotland: Scoping Report NHS Highland

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 and 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 Highland, Raigmore Hospital indicated that they currently provide dedicated facilities for women experiencing unexpected pregnancy complications at any gestation. These dedicated facilities are located within the EPU in Raigmore Hospital with lack of space cited as the reason that dedicated facilities are not provided outwith the EPU. Dr Mackinnon Memorial Hospital cited staff recruitment, staff retention, and staff training as reasons for not providing dedicated facilities for women experiencing unexpected pregnancy complications at any gestation while Caithness General Hospital and Belford Hospital indicated that these services are centralised in Raigmore Hospital. For all sites in Argyll and Bute, women are referred to NHS Greater Glasgow and Clyde (Table 11).

As Nairn Town and County Hospital does not have an EPU, maternity unit, CMU or an Obstetrics and Gynaecology Department they were not asked this question.

Separate room/area/ward

All sites 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 in Scotland.

In NHS Highland, Raigmore Hospital reported they provide a separate room, area, or ward away from the labour ward for women that are miscarrying within the EPU, they do not provide a separate room, area, or ward away from the labour ward for women that are miscarrying outwith the EPU, with a lack of space provided as the reason for not providing this. However, if women need admitted a separate room is available within the gynaecology ward. Raigmore Hospital also reported that they provide a separate room, area, ward or unit with dedicated services to admit women within the EPU.

Dr Mackinnon Memorial Hospital cited staff recruitment, staff retention, and staff training as reasons for not providing dedicated facilities for women experiencing unexpected pregnancy complications at any gestation while Caithness General Hospital and Belford Hospital indicated that these services are centralised in Raigmore 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. The facilities that are provided are set out in Table 11 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 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 Highland, scans are conducted in the EPU at Raigmore Hospital between 9:00 and 12:00 Monday, Tuesday, Thursday and Friday. These scans are conducted in the same area as other expectant mothers. Raigmore Hospital cited lack of space as the reason that they do not have a separate area away from women with a continuing pregnancy to carry out these scans. Scans are also carried out in the Maternity Unit at Raigmore Hospital between 9:00 and 16:00 Monday to Friday, Obstetrics and Gynaecology department 9:00 to 16:00 Monday to Friday and the Recurrent Miscarriage Clinic 9:00 to 12:00 Monday, Tuesday, Thursday and Friday.

If a woman presents with a suspected miscarriage out of hours at Raigmore Hospital A&E there are no out of hours scan facilities available. Patients from A&E would be transferred to gynaecology ward where they would be assessed, the majority of patients are then discharged for referral/follow up with EPU. The majority of patients that present for miscarriage are assessed and scanned at the EPU in Raigmore Hospital. Occasionally emergency admissions to the gynaecology ward are scanned by the obstetric scan team on an emergency basis.

At Caithness General Hospital scans cannot be performed locally during the night although scans can be performed 9:00-17:00 Monday and Thursday. If there is an emergency, a scan can be conducted outwith these times if available. All other sites would refer women for scans to the EPU at Raigmore Hospital. For sites in Argyll and Bute women are referred to NHS Greater Glasgow and Clyde (Table 12).

As Nairn Town and County Hospital does not have an EPU, maternity unit, CMU or an Obstetrics and Gynaecology Department they were not asked this question.