Miscarriage Care and Facilities in Scotland: Scoping Report NHS Tayside

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.

Within NHS Tayside, Ninewells Hospital indicated that they currently provide dedicated facilities for women experiencing unexpected pregnancy complications at any gestation both within and outwith the EPU (Table 12).

Separate room/area/ward for women experiencing miscarriage

All sites 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 Tayside, Ninewells Hospital reported that they provide a separate room/area/ward for women who are miscarrying as well as a separate room area/ward/unit with dedicated services to admit women who are miscarrying away from the labour ward. These separate areas are available both within and outwith the EPU and there are more than five single rooms available in maternity assessment and the gynaecology ward. At Ninewells Hospital for first trimester losses side rooms in the gynaecology ward are available, for second trimester losses dedicated rooms in the labour ward away from labouring women or postnatal women are available. These spaces are also available for use for women experiencing still births, termination of pregnancy due to fetal anomaly (TOPFA), ectopic and molar pregnancies. The facilities that are provided are set out in Table 12 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 Tayside, Ninewells Hospital reported that scans are conducted in the Early Pregnancy Unit during opening hours. If a woman presents out of hours at Ninewells Hospital A&E department or at one of the other two sites with a suspected miscarriage and a scan is required, the woman would be referred to EPU during opening hours the next day if she is stable, care would be provided in the EPU along with the on-call gynaecology team.

NHS Tayside also have the facilities to conduct scans within their Maternity Unit and Obstetrics and Gynaecology Department or gynaecology ward 24 hours a day, seven days a week when staff with the appropriate skills are present. When a woman presents out of hours and is not in a stable condition an investigative scan would take place immediately by an appropriately qualified member of medical staff. All scans are carried out separated from other expectant mothers.

Arbroath Infirmary and Perth Royal Infirmary indicated that they have the facilities to conduct scans in their Community Maternity Units but reported that all women are transferred to Ninewells Hospital for investigation for miscarriage. No scans are conducted at A&E departments across all three sites.