Miscarriage Care and Facilities in Scotland: Scoping Report NHS Lothian

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 Lothian, both sites reported that they provide dedicated facilities for all women experiencing unexpected pregnancy complications at any gestation; the Royal Infirmary of Edinburgh however, states that this is only provided in the first trimester (up to 12 weeks) within the EPU (Table 11).

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 Lothian, St John’s Hospital said that they provide a separate room/area/ward for women who are miscarrying and a separate room area/ward/unit with dedicated services to admit women who are miscarrying. At St John’s Hospital these are provided both within and outwith the EPU. St John’s Hospital stated that there are four to five rooms; one dedicated family room for pregnancy loss within the Women's Services footprint and three single rooms that can be used for admitting women experiencing pregnancy loss if the family room is occupied. Royal Infirmary of Edinburgh reported that they provide a separate room/area/ward for women who are miscarrying both within and outwith the EPU, however this is only provided in the first trimester (up to 12 weeks) within the EPU. Edinburgh Royal Infirmary also stated that they provide a separate room area/ward/unit with dedicated services to admit women who are miscarrying, however this is dependent on gestation, with the EPU admitting women under 12 weeks gestation only. In Royal Infirmary of Edinburgh there are two rooms on the gynaecology ward for admitting women who are miscarrying, however this can be dependent on availability. At both sites these 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 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 Lothian, scans are conducted in the Early Pregnancy Units at both Royal Infirmary of Edinburgh and St John’s Hospital during opening hours, however scans are conducted in the same area as other expectant mothers within the EPU. Both hospitals in NHS Lothian stated that space, finance/cost and lack of equipment were the main reasons that scans were not available separated from women with a continuing pregnancy.

Outwith the EPU in the Royal Infirmary of Edinburgh and St John’s Hospital scans are conducted in the same area as other expectant mothers also, this was due to space, finance/cost, staff training and a lack of equipment. At St John’s Hospital all early pregnancy scanning is performed within the main obstetric ultrasound department and women then attend the EPU following their scan to discuss ongoing management with the EPU nursing staff.

There are no out of hours scanning facilities available at St John's or Royal Infirmary of Edinburgh (evenings and weekends).