Miscarriage Care and Facilities in Scotland: Scoping Report NHS Orkney
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 21 alongside the recommendations within the Lancet Series on Miscarriage Matters and the Scottish Government Programme for Government commitments.
In NHS Orkney, Balfour Hospital is the core site that provides care for women that experience miscarriage.
In NHS Orkney, Balfour Hospital provides written information about the treatment options for the management of miscarriage and what to expect next in terms of miscarriage.
Within NHS Orkney women are 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. Women are free to choose their preferred management approach based on their needs and preferences.
In NHS Orkney a graded approach to treatment of recurrent miscarriage is provided at Balfour Hospital. Balfour Hospital reported that due to the smaller size of maternity services in NHS Orkney, screening for mental health issues and referral to services for management and optimisation of chronic maternal medical conditions are not provided on site, however women would be referred to appropriate teams within the Health Board area.
Within NHS Orkney, Balfour Hospital indicated that they do not have dedicated facilities for women experiencing unexpected pregnancy complication at any gestation due to lack of space, however there is one room available within the Maternity Unit that is away from the postnatal and labour areas.
In NHS Orkney, Balfour Hospital does not have a separate area to carry out complication/investigative scans separated from women with a continuing pregnancy.
In NHS Orkney data on miscarriage is collected via BadgerNet and Trakcare. Data is collected on the number of miscarriages, miscarriages as a proportion of pregnancies, gestation, maternal age, parity and ethnicity. There is currently no data collected on SIMD.
Source |
Commitment/Recommendation |
Service provision in NHS Orkney |
|---|---|---|
PfG |
Ensure women's services in Health Boards have dedicated facilities for women who are experiencing unexpected pregnancy complications. |
NHS Orkney Balfour Hospital indicated that they do not have dedicated facilities for women experiencing unexpected pregnancy complication at any gestation due to lack of space, however there is one room available within the Maternity Unit that is away from the postnatal and labour areas. |
The Lancet: Miscarriage Matters |
A graded approach to the treatment of recurrent miscarriage |
In NHS Orkney a graded approach to treatment of recurrent miscarriage is provided at Balfour Hospital |
After first miscarriage |
||
After the first miscarriage, women will be guided to information about miscarriage |
Provided at Balfour Hospital. |
|
After the first miscarriage, women will be guided to resources to address their physical needs |
Provided at Balfour Hospital. |
|
After the first miscarriage, women will be guided to resources to address mental health needs following pregnancy loss |
Provided at Balfour Hospital. |
|
After the first miscarriage, women will be guided to ways to optimise their health for future pregnancy |
Provided at Balfour Hospital. |
|
After first miscarriage - this approach could involve: |
||
Patient support groups |
Provided at Balfour Hospital. |
|
Online self-help strategies for mental health |
Provided at Balfour Hospital. |
|
Weight management |
Provided at Balfour Hospital. |
|
Smoking and recreational drugs cessation services |
Provided at Balfour Hospital. |
|
Information on appropriate preconceptual folate and vitamin D supplementation |
Provided at Balfour Hospital. |
|
Referral to necessary services for management and optimisation of chronic maternal medical conditions (e.g., diabetes, hypertension, heart disease, and epilepsy) |
Provided at Balfour Hospital. |
|
Screening for mental health issues. |
Referred to appropriate team within the Health Board. |
|
After second miscarriage |
||
Women will be offered an appointment at a miscarriage clinic nurse or midwifery-led |
Not provided in NHS Orkney |
|
Continuity of Care |
Provided at Balfour Hospital. |
|
Tests for full blood count are offered |
Provided at Balfour Hospital. |
|
Tests for thyroid function are offered |
Provided at Balfour Hospital. |
|
Discussion about lifestyle issues |
Provided at Balfour Hospital. |
|
Referral for specialist care will be arranged if tests are abnormal or if there is a chronic medical or mental health problem. |
Referred to appropriate team within the Health Board. |
|
Women will have access to support and early pregnancy reassurance scans in subsequent pregnancies. |
Provided at Balfour Hospital. |
|
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 Balfour Hospital or referred outwith Health Board area. |
|
Pregnancy tissue from the third and any subsequent miscarriages will be sent for genetic testing. |
Provided at Balfour Hospital. |
|
Blood tests for antiphospholipid antibodies will be arranged. |
Provided at Balfour Hospital. |
|
A pelvic ultrasound scan (ideally three dimensional transvaginal) will be arranged |
Provided at Balfour Hospital. |
|
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 Balfour Hospital. |
|
Appropriate screening for mental health issues |
Referred to appropriate team within the Health Board |
|
Appropriate care for mental health issues |
Referred to appropriate team within the Health Board |
|
Overall recommendations |
||
Appropriate screening and care for future obstetric risks, particularly preterm birth, fetal growth restriction, and stillbirth. |
Referred to appropriate team within the Health Board. |
|
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. |
Referred to appropriate team within the Health Board. |
|
Consider giving vaginal micronised progesterone in women with early pregnancy bleeding and a history of miscarriage |
Not currently provided in NHS Orkney. |
|
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. |
Balfour Hospital reported that they have staff with additional specialist training to deal with all baby losses including miscarriage and stillbirth and specialised medical staff to deal with recurrent miscarriage at this site. Doctors at Balfour Hospital 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 |
Balfour Hospital provides all management options on site, however these are only offered in the first trimester. For all second trimester losses this is provided outwith the Health Board |
|
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. |
NHS Orkney reported that data is collected via BadgerNet and Trakcare. Data is collected on the number of miscarriages, miscarriages as a proportion of pregnancies, gestation, maternal age, parity and ethnicity. There is currently no data collected on SIMD. |
|
Identifying women at risk of psychological distress following miscarriage |
Referred to appropriate team within the Health Board |
|
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 Balfour Hospital |
|
Miscarriage Management - women should be presented with the available evidence and be free to choose the management approach that suits their needs and preferences |
Within NHS Orkney women are 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. Women are free to choose their preferred management approach based on their needs and preferences. |
|
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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