Miscarriage Care and Facilities in Scotland: Scoping Report NHS Western Isles
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 shown in Table 22 alongside the recommendations within the Lancet series on Miscarriage Matters and the Scottish Government Programme for Government commitments.
In NHS Western Isles, women who are experiencing a miscarriage may present at Uist and Barra Hospital, Barra Community Hospital or Western Isles Hospital. However, all sites noted that women would be transferred to the Maternity Unit at Western Isles Hospital if intervention was required. All sites in NHS Western Isles said that women are free to choose the management approach that suits their needs.
In NHS Western Isles, it was reported that women are provided with written information on treatment options for the management of miscarriage and what to expect next in terms of miscarriage care. All three sites also indicated that women are provided with written information on services for mental health and bereavement following a loss.
Within NHS Western Isles 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 Western Isles a graded approach to treatment of recurrent miscarriage care is provided at both Western Isles Hospital and Uist and Barra Hospital.
In NHS Western Isles, Western Isles Hospital does not currently provide screening for mental health issues due to staff recruitment and staff training. They also do not provide development of an individualised health plan, although this service is currently being developed. Appointments at nurse-led and midwifery-led, miscarriage clinics and continuity of carer are not provided at any site in NHS Western Isles, however, at Western Isles Hospital women are offered an appointment at a consultant-led miscarriage clinic after three miscarriages.
Within NHS Western Isles, Western Isles Hospital indicated that they currently provide dedicated facilities for women experiencing unexpected pregnancy complications at any gestation. There are two rooms available for women who are miscarrying on the maternity ward. Although these rooms are located in the maternity ward, they are away from the labour and main wards.
In NHS Western Isles there are currently no separate areas to conduct scans away from women with a continuing pregnancy.
In NHS Western Isles data is collected via BadgerNet and from patient GP records. Data is collected on the number of miscarriages, miscarriages as a proportion of pregnancies, gestation, maternal age, parity and ethnicity varies depending on the site.
Source |
Commitment/Recommendation |
Service provision in NHS Western Isles |
|---|---|---|
PfG |
Ensure women's services in Health Boards have dedicated facilities for women who are experiencing unexpected pregnancy complications. |
Within NHS Western Isles, Western Isles Hospital indicated that they currently provide dedicated facilities for women experiencing unexpected pregnancy complications at any gestation. There are two rooms available women who are miscarrying on the maternity ward, away from the labour and main wards. It is noted that some rooms/areas are not solely used for miscarriage care and may be used for other pregnancy complications or loss. |
The Lancet: Miscarriage Matters |
A graded approach to the treatment of recurrent miscarriage. |
A graded approach to treatment of recurrent miscarriage is provided at Western Isles Hospital and Uist and Barra Hospital. |
After first miscarriage |
||
After the first miscarriage, women will be guided to information about miscarriage |
Provided at Western Isles Hospital and Uist and Barra Hospital. |
|
After the first miscarriage, women will be guided to resources to address their physical needs |
Provided at Western Isles Hospital and Uist and Barra Hospital. |
|
After the first miscarriage, women will be guided to resources to address mental health needs following pregnancy loss |
Provided at Western Isles Hospital and Uist and Barra Hospital. |
|
After the first miscarriage, women will be guided to ways to optimise their health for future pregnancy |
Provided at Western Isles Hospital and Uist and Barra Hospital. |
|
After first miscarriage - this approach could involve: |
||
Patient support groups |
Provided at Western Isles Hospital and Uist and Barra Hospital. |
|
Online self-help strategies for mental health |
Provided at Western Isles Hospital and Uist and Barra Hospital. |
|
Weight management |
Provided at Western Isles Hospital and Uist and Barra Hospital. |
|
Smoking and recreational drugs cessation services |
Provided at Western Isles Hospital and Uist and Barra Hospital. |
|
Information on appropriate preconceptual folate and vitamin D supplementation |
Provided at Western Isles Hospital and Uist and Barra Hospital. |
|
Referral to necessary services for management and optimisation of chronic maternal medical conditions (e.g., diabetes, hypertension, heart disease, and epilepsy) |
Provided at Uist and Barra Hospital. |
|
Screening for mental health issues. |
Provided at Uist and Barra Hospital. |
|
After second miscarriage |
||
Women will be offered an appointment at a miscarriage clinic nurse or midwifery-led |
Not provided in NHS Western Isles. |
|
Continuity of Care |
Provided at Uist and Barra Hospital. |
|
Tests for full blood count are offered |
Provided at Western Isles Hospital and Uist and Barra Hospital. |
|
Tests for thyroid function are offered |
Provided at Western Isles Hospital and Uist and Barra Hospital. |
|
Discussion about lifestyle issues |
Provided at Western Isles Hospital and Uist and Barra Hospital. |
|
Referral for specialist care will be arranged if tests are abnormal or if there is a chronic medical or mental health problem. |
Provided at Western Isles Hospital. |
|
Women will have access to support and early pregnancy reassurance scans in subsequent pregnancies. |
Provided at Western Isles Hospital and Uist and Barra 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 Western Isles Hospital. |
|
Pregnancy tissue from the third and any subsequent miscarriages will be sent for genetic testing. |
Not Provided in NHS Western Isles. |
|
Blood tests for antiphospholipid antibodies will be arranged. |
Provided at Western Isles Hospital. |
|
A pelvic ultrasound scan (ideally three dimensional transvaginal) will be arranged. |
Provided at Western Isles 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. |
Not Provided in NHS Western Isles. |
|
Appropriate screening for mental health issues. |
Provided at both Western Isles Hospital and Uist and Barra Hospital. |
|
Appropriate care for mental health issues. |
Provided at Western Isles Hospital. Uist and Barra Hospital can refer to Western Isles Hospital. |
|
Overall recommendations |
||
Appropriate screening and care for future obstetric risks, particularly preterm birth, fetal growth restriction, and stillbirth. |
Provided at Western Isles Hospital and Uist and Barra Hospital. |
|
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. |
Provided at Western Isles Hospital and Uist and Barra Hospital. |
|
Consider giving vaginal micronised progesterone in women with early pregnancy bleeding and a history of miscarriage. |
Provided at Western Isles Hospital. |
|
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. |
Western Isles Hospital has midwives/nurses with additional specialist training to provide comprehensive miscarriage care. Western Isles Hospital has doctors trained to provide comprehensive miscarriage care. Uist and Barra Hospital and Barra Community Hospital can refer women to Western Isles Hospital. |
|
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. |
Scans are conducted at Western Isles Hospital in the same area as other expectant women. All management options are available at Western Isles Hospital. |
|
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. |
In NHS Western Isles data is collected via BadgerNet and from patient GP records. Data is collected on the number of miscarriages, miscarriages as a proportion of pregnancies, gestation, maternal age, parity and ethnicity varies depending on the site. |
|
Identifying women at risk of psychological distress following miscarriage. |
Provided at Uist and Barra Hospital. |
|
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 Western Isles Hospital and Uist and Barra 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. |
All sites in NHS Western Isles all sites said that women are free to choose the management approach that suits their needs. |
|
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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