Miscarriage Care and Facilities in Scotland: Scoping Report NHS Orkney

Opening hours of miscarriage care services

Maternity opening hours in NHS Orkney

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).

In NHS Orkney the EPU is incorporated into the whole service and is not a separate dedicated provision. The services typically provided by an early pregnancy unit are provided through the whole service approach adopted at Balfour Hospital. The number of women presenting, and the size of the service currently means there is no separate department or area, and all services are run from the maternity unit. Balfour Hospital indicated that although women mainly prefer to access the support and expertise of the maternity team within the maternity unit options are available for alternative accommodation in the acute or day surgery wards if women prefer not to attend the maternity unit. Regardless, access to midwifery input is always available.

As the services that provide miscarriage care are a whole service approach, the services provided in terms of an EPU, maternity unit, community maternity unit and obstetrics and gynaecology are available to women when needed.

Recurrent miscarriage services

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

NHS Orkney reported that Recurrent Miscarriage Clinics are run at Balfour Hospital 14:00-16:00 on Wednesdays (Table 6).

Infertility services

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

NHS Orkney reported that infertility services run 10:30-16:00 on Wednesdays (Table 7).

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.

In NHS Orkney, Balfour Hospital has an accident and emergency facility 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 varied both within and between health boards.

Balfour Hospital was asked what would happen if a woman presents at A&E with suspected miscarriage through the night (out of hours) within NHS Orkney. Balfour Hospital reported that the on call gynaecologist is called and if the woman requires admission, they are transferred to the maternity unit or another department should this be preferred by the woman. Options for management would then be discussed as per clinical presentation and guidance, then agreed with the woman.