Miscarriage Care and Facilities in Scotland: Scoping Report NHS Lothian

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 Lothian reported that the Early Pregnancy Unit (EPU) at Royal Infirmary of Edinburgh is open 08:30-17:30 Monday to Friday and 08:30-16:30 Saturday and Sunday. The EPU at St John’s Hospital is open 08:30-17:00 Monday to Friday and closed on Saturday and Sunday. While the EPU is deemed the main location that those experiencing miscarriage would be seen, treatment outwith these hours is delivered within the Obstetrics and Gynaecology Departments at each site. (Table 6).

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.

In NHS Lothian, both St John’s Hospital and Royal Infirmary of Edinburgh have maternity units that are 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 Lothian does not have any Community Maternity Units.

Obstetrics and Gynaecology

21 of the 44 sites said they had an Obstetrics and Gynaecology department. This was across all 14 Health Boards areas.

In NHS Lothian both St John’s Hospital and Royal Infirmary of Edinburgh have Obstetrics and Gynaecology departments. These departments open and 24 hours a day seven days a week at the Royal Infirmary of Edinburgh and at St John’s Hospital (Table 8).

Recurrent miscarriage services

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

In NHS Lothian Recurrent Miscarriage Clinics are operated from both St John’s Hospital and Royal Infirmary of Edinburgh. These clinics run 09:00-12:30 every two weeks on a Monday at St John’s Hospital and 09:00-12:00 every two weeks on a Thursday at the Royal Infirmary of Edinburgh (Table 9).

Infertility services

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

In NHS Lothian infertility services are operated from the Royal Infirmary of Edinburgh Monday to Friday 08:00-17:00 (Table 10).

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.

NHS Lothian reported that both St John’s Hospital and the Royal Infirmary of Edinburgh haven A&E departments which are open 24 hours seven days a week.

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 vary both within and between Health Boards.

Sites in NHS Lothian were asked what would happen if a woman presents at A&E with suspected miscarriage through the night (out of hours). Both sites reported that A&E staff would triage the patient and refer them to the on call gynaecologist who reviews the patient.

At St John’s Hospital if there is high suspicion of ectopic pregnancy or heavy bleeding and pain, the patient would be admitted and offered an ultrasound scan the next working day within opening hours of the EPU. If the patient is stable a referral is made for the patient to be seen at the EPU at their site the following day within opening hours. At St. John’s Hospital, if the patient was experiencing a suspected ectopic pregnancy requiring an urgent emergency ultrasound scan they would be transferred to another site that offers 7 day emergency scanning.

At Edinburgh Royal Infirmary staff would refer the patient to Pregnancy Support during the day and a scan would be provided if appropriate, at night there is no scanning facilities.