Miscarriage Care and Facilities in Scotland: Scoping Report NHS Lanarkshire
This report details the findings of a scoping exercise to better understand miscarriage care in Scotland within this Health Board. The individual Health Board reports and the national report seek to aid policy makers and Health Boards in making decisions about improvements to Miscarriage Care
Summary
A summary of findings is presented below and is shown in Table 25 alongside the recommendations within the Lancet series on Miscarriage Matters and the Scottish Government Programme for Government commitments.
In NHS Lanarkshire, University Hospital Wishaw is the core site that provides care for women that experience miscarriage. All three sites in NHS Lanarkshire said that women are free to choose the management approach that suits their needs.
In NHS Lanarkshire, all three sites provide written information about the treatment options for the management of miscarriage and what to expect in terms of miscarriage care and information on what would happen before, during and after any treatment options.
Within NHS Lanarkshire women are also provided with full explanations about what would happen during their chosen method of management, after the chosen method of management and in terms of follow-up. This would be provided at University Hospital Wishaw.
In NHS Lanarkshire a graded approach to treatment of recurrent miscarriage is provided at University Hospital Wishaw. Most of the elements outlined in the Lancet series on Miscarriage Matters are provided in NHS Lanarkshire after a third and subsequent miscarriage. While appropriate screening form mental health issues is not routinely implemented University Hospital Wishaw indicated that a mental health pathway is being developed for all women who present at the EPU at University Hospital Wishaw. After a second miscarriage NHS Lanarkshire does not provide nurse or midwifery led miscarriage clinic, however discussions are ongoing regarding implementing appointments at midwifery led clinics in University Hospital Wishaw.
Dedicated facilities are available at University Hospital Wishaw in NHS Lanarkshire, where three separate rooms are available away from the labour ward for women that are miscarrying. University Hospital Hairmyres has dedicated facilities within the EPU.
In NHS Lanarkshire, University Hospital Wishaw has a separate area to carry out complication/investigative scans separated from women with a continuing pregnancy. University Hospital Hairmyres can provide this within the EPU.
In NHS Lanarkshire data on miscarriage is collected via Badgernet and Trakcare. Currently University Hospital Monklands and University Hospital Wishaw collect data including the number of miscarriages, miscarriages as a proportion of pregnancies, gestation, maternal age, parity, ethnicity and SIMD. Similarly, University Hospital Hairmyres collects the same data excluding parity, SIMD and ethnicity.
Source |
Commitment/Recommendation |
Progress in NHS Lanarkshire |
|---|---|---|
PfG |
Ensure women's services in Health Boards have dedicated facilities for women who are experiencing unexpected pregnancy complications. |
NHS Lanarkshire have dedicated provisions for women experiencing unexpected pregnancy complications at University Hospital Wishaw and University Hospital Hairmyres; these facilities are provided in the Early Pregnancy Unit (EPU) at University Hospital Hairmyres and both within and outwith the EPU at University Hospital Wishaw. University Hospital Wishaw can use two separate rooms for those experiencing miscarriage and University Hospital Hairmyres can use one counselling room. It is noted that some rooms/areas are not solely used for miscarriage care and may be used for other pregnancy complications or loss. |
The Lancet: Miscarriage Matters |
A graded approach to the treatment of recurrent miscarriage |
In NHS Lanarkshire a graded approach to treatment of recurrent miscarriage is provided at University Hospital Wishaw. |
After First Miscarriage |
||
After the first miscarriage, women will be guided to information about miscarriage |
Provided at University Hospital Hairmyres, University Hospital Wishaw and University Hospital Monklands. |
|
After the first miscarriage, women will be guided to resources to address their physical needs |
Provided at University Hospital Hairmyres and University Hospital Wishaw. |
|
After the first miscarriage, women will be guided to resources to address mental health needs following pregnancy loss |
Provided at University Hospital Hairmyres and University Hospital Wishaw. |
|
After the first miscarriage, women will be guided to ways to optimise their health for future pregnancy |
Provided at University Hospital Wishaw. |
|
After First Miscarriage – this approach could involve: |
||
Patient support groups |
Provided at University Hospital Hairmyres, University Hospital Wishaw and University Hospital Monklands. |
|
Online self-help strategies for mental health |
Provided at University Hospital Monklands and University Hospital Wishaw. |
|
Weight management |
Provided at University Hospital Hairmyres and University Hospital Wishaw. |
|
Smoking and recreational drugs cessation services |
Provided at University Hospital Hairmyres and University Hospital Wishaw. |
|
Information on appropriate preconceptual folate and vitamin D supplementation |
Provided at University Hospital Hairmyres and University Hospital Wishaw. |
|
Referral to necessary services for management and optimisation of chronic maternal medical conditions (e.g., diabetes, hypertension, heart disease, and epilepsy) |
Provided at University Hospital Wishaw. |
|
Screening for mental health issues. |
Not provided plans to implement in the next two years. Referral to other services such as counselling and bereavement or Maternity and Neonatal Psychological Intervention Service at University Hospital Wishaw. |
|
After Second Miscarriage |
||
Women will be offered an appointment at a miscarriage clinic nurse or midwifery-led |
Not provided in NHS Lanarkshire- plans to implement in next 2 years. |
|
Continuity of Carer |
Provided at University Hospital Wishaw. |
|
Tests for full blood count are offered |
Provided at University Hospital Wishaw. |
|
Tests for thyroid function are offered |
Provided at University Hospital Wishaw. |
|
Discussion about lifestyle issues |
Provided at University Hospital Hairmyres. |
|
Referral for specialist care will be arranged if tests are abnormal or if there is a chronic medical or mental health problem. |
Provided at University Hospital Wishaw. |
|
Women will have access to support and early pregnancy reassurance scans in subsequent pregnancies. |
Provided at University Hospital Hairmyres and University Hospital Wishaw. |
|
After Third and Subsequent Miscarriage |
||
Women will be offered an appointment at a medical consultant-led clinic, in which additional tests and a full range of treatments can be offered. |
Provided at University Hospital Wishaw. |
|
Pregnancy tissue from the third and any subsequent miscarriages will be sent for genetic testing. |
Provided at University Hospital Wishaw. |
|
Blood tests for antiphospholipid antibodies will be arranged. |
Provided at University Hospital Wishaw. |
|
A pelvic ultrasound scan (ideally three dimensional transvaginal) will be arranged |
Provided at University Hospital Wishaw. |
|
If necessary, parental karyotyping will be offered depending on the clinical history and the results of the genetic analysis of pregnancy tissue from previous losses |
Provided at University Hospital Wishaw. |
|
Appropriate screening for mental health issues |
Provided at University Hospital Wishaw. |
|
Appropriate care for mental health issues |
Provided at University Hospital Wishaw. |
|
Overall Recommendations |
||
Appropriate screening and care for future obstetric risks, particularly preterm birth, fetal growth restriction, and stillbirth. |
Provided at University Hospital Wishaw. |
|
Appropriate screening and care for future obstetric risks and mental health issues will need to be incorporated into the care pathway for couples with a history of recurrent miscarriage. |
Provided at University Hospital Wishaw and University Hospital Hairmyres. |
|
Consider giving vaginal micronised progesterone in women with early pregnancy bleeding and a history of miscarriage |
Provided at University Hospital Hairmyres. |
|
We urge health-care funders and providers to 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. |
University Hospital Wishaw have midwives/nurses with additional specialist training to provide comprehensive miscarriage care, doctors are also trained to provide comprehensive miscarriage care. |
|
Early pregnancy services need to focus on providing an effective ultrasound service, as it is central to the diagnosis of miscarriage, and be able to provide expectant management of miscarriage, medical management with mifepristone and misoprostol, and surgical management with manual vacuum aspiration |
University Hospital Wishaw and University Hospital Hairmyres reported that they conduct scans in their Early Pregnancy Unit during opening hours in an area separate from other expectant mothers. Expectant management is provided at University Hospital Wishaw and University Hospital Hairmyres. Medical management with mifepristone and misoprostol is provided at University Hospital Wishaw. Surgical management with manual vacuum aspiration is provided at University Hospital Wishaw for first trimester losses. |
|
Recommend that miscarriage data are gathered and reported to facilitate comparison of rates among countries, to accelerate research, and to improve patient care and policy development. We recommend that every country reports annual aggregate miscarriage data, similarly to the reporting of stillbirth. |
Data on miscarriage is collected via Badgernet and Trakcare. University Hospital Monklands and University Hospital Wishaw collect data including the number of miscarriages, miscarriages as a proportion of pregnancies, gestation, maternal age, parity, ethnicity and SIMD. University Hospital Hairmyres collects the same data excluding parity, SIMD and ethnicity. |
|
Identifying women at risk of psychological distress following miscarriage |
Not provided in NHS Lanarkshire. |
|
Identifying women at risk of psychological distress following miscarriage and the development of optimal treatment strategies have been recognised as research priorities. |
Not assessed |
|
Women with a history of miscarriage, particularly those with three or more miscarriages, are at an increased risk of obstetric complications including preterm birth. Therefore, these women should be treated as patients at high risk during antenatal and intrapartum care. |
Provided at University Hospital Wishaw. |
|
Miscarriage Management - women should be presented with the available evidence and be free to choose the management approach that suits their needs and preferences |
University Hospital Hairmyres, University Hospital Wishaw and University Hospital Monklands, stated that women are free to choose the management approach that suits their needs. |
|
Consider pathways of care for miscarriage management, treatment of women with a history of miscarriage and care following a miscarriage. |
Not assessed |
|
The Lancet: Miscarriage Matters Research Recommendations |
Key epidemiological research priority 1 - Establishing how we can monitor miscarriage rates on a population basis. |
Project underway with Scottish Government and Public Health Scotland |
Key epidemiological research priority 2 - Ascertaining if miscarriage risk and prevalence differ across nations and ethnic groups. |
Project underway with Scottish Government and Public Health Scotland |
|
Key epidemiological research priority 3 - Whether miscarriage rate is increasing, and if so why; what the key outcomes are from women's point of view. |
Work to follow from research priorities 1 and 2 above. |
|
Key epidemiological research priority 4 - Which risk factors for miscarriage are potentially causative and modifiable; and the effect of modification of the risk factor on clinical outcomes |
Work to follow from research priorities 1 and 2 above. |
|
Contact
Email: socialresearch@gov.scot
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