Miscarriage Care and Facilities in Scotland: Scoping Report NHS Tayside

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).

In NHS Tayside, Ninewells Hospital reported that the Early Pregnancy Unit (EPU) is open 08:30-16:30 Monday to Friday and closed on Saturdays and Sundays. While the EPU is deemed the main location that those experiencing miscarriage would be seen, treatment outwith these hours would be at the maternity unit or obstetrics and gynaecology department at Ninewells hospital, where the EPU is also based (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 Tayside Ninewells Hospital indicated that they have a Maternity Unit that is open 24 hours a day seven days a week and (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.

All sites in NHS Tayside reported that they have Community Maternity Units (CMU). The CMU at Ninewells Hospital is open 24 hours 7 days a week; the CMU at Arbroath Infirmary is open Monday to Sunday 07:30-17:30 with an on-call service 17:30-07:30 and the CMU at Perth Royal Infirmary is open Monday to Sunday 07:30-17:30 with an on-call service 17:30-07:30 (Table 8).

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 Tayside, Ninewells Hospital Obstetrics and Gynaecology department is open 24 hours a day 7 days a week. The Obstetrics and Gynaecology department at Perth Royal Infirmary is open 08.30-16.00 Monday to Friday for appointments and closed on Saturday and Sunday, out with these hours care is provided at Ninewells Hospital through the department or on call. (Table 9).

Recurrent miscarriage services

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

In NHS Tayside, Ninewells Hospital run recurrent miscarriage clinics (RMC) 09:00-13:00 on alternate Fridays with 24 clinics available annually. While the other two sites do not have recurrent miscarriage services (Table 10).

Infertility services

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

In NHS Tayside, Ninewells Hospital run infertility services 09:00–17:00 Monday to Fridays with only emergency access work on weekends (Table 11).

Accident and Emergency

37 of the 44 sites said they have an 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 Tayside reported that Ninewells Hospital has an A&E department that is open 24 hours.

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

Sites were asked what would happen if a woman presents at A&E with suspected miscarriage through the night (out of hours) within NHS Tayside. Ninewells Hospital reported that if a woman presents at A&E with suspected miscarriage through the night (out of hours) at Ninewells Hospital, A&E would contact the on-call gynaecology registrar at Ninewells Hospital to inform them of the case presentation. The on-call team at Ninewells Hospital would review and manage the patient and assess them overnight, the team would assess and devise a treatment plan including whether surgery is required. If the overnight assessment indicates the patient is stable, they are managed by the medical team the following morning.

Perth Royal Infirmary reported that women who present at minor injuries are referred to the on-call registrar. There is no A&E attached to Arbroath Infirmary.