Miscarriage Care and Facilities in Scotland: Scoping Report NHS Shetland

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 Shetland the Gilbert Bain Hospital can provide dedicated facilities for women experiencing unexpected pregnancy complications at any gestation. At the time of completion of this questionnaire NHS Shetland provided care up to and including 12 completed weeks of pregnancy, however, a new bereavement suit which is under construction will enable NHS Shetland to provide care up to 22 weeks gestation (Table 9).

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 Shetland, the Gilbert Bain Hospital does not have an EPU. Patients experiencing miscarriage would be transferred to the Maternity Unit within Gilbert Bain Hospital. There is no separate room/area/ward away from the labour ward or dedicated facilities to admit women who are miscarrying, although there is one room available for use of women who require early pregnancy care up to 12 weeks gestation. This room is also used for women experiencing ectopic pregnancies. NHS Shetland do not offer termination of pregnancy due to fetal anomaly (TOPFA), this is provided in NHS Grampian. In NHS Shetland the numbers of miscarriages have historically been low. As a Board there are approximately 150 births per year and there has been a reduction in this number over time. NHS Shetland is currently redesigning the maternity unit to create a space for bereaved families, this will include a bereavement suite with a separate entrance. This will enable an increase in the gestation cared for from 12 weeks to up to 22 weeks. Outside these gestations the Gilbert Bain Hospital would continue to refer to a tertiary centre (NHS Grampian). To coincide with the bereavement suite opening there is a planned launch of new guidelines along with training to support service delivery.

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 Shetland, scans are provided in the Maternity Unit by the midwife sonographers, with consultants available for scans out of hours. These scans are carried out in the same area as women with a continuing pregnancy (Table 10).

No scans to confirm miscarriage are conducted at Obstetrics and Gynaecology or A&E departments on this site.