Miscarriage Care and Facilities in Scotland: Scoping Report National Overview

Opening hours of miscarriage care services

The following section details service provision within each Health Board overall, further details at a site level is available in the 14 individual Health Board reports that have been published alongside this national report.

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 ofdedicated Early Pregnancy Units.

All Health Boards in Scotland said they provide early pregnancy services. 10 Health Boards have a dedicated early pregnancy unit (Table 2).

The opening times of EPUs varies across Scotland, the majority are open on weekdays with wider variation at the weekend. On Saturdays eight EPU sites are open and five are open on Sundays (Table 5). Boards reported that when the EPU is closed other facilities are provided for women experiencing miscarriage either through emergency departments or obstetrics and gynaecology teams, or through transferring to another site within the Health Board area.

Four of the Health Boards in Scotland do not have a dedicated early pregnancy unit, however they all provide some early pregnancy services. This is often due to local circumstances, space and costs. In NHS Dumfries and Galloway, NHS Orkney and NHS Western Isles while there is no dedicated early pregnancy unit, early pregnancy services are available within existing maternity services in the sites where women would be directed for miscarriage care. At the time of the questionnaire NHS Shetland offered care for miscarriage up to 12 completed weeks of pregnancy primarily through the local Maternity Unit. For losses in later pregnancy, women are transferred to NHS Grampian. However, in NHS Shetland building work has commenced on a new bereavement suite for parents which will enable care to be offered up to 22 weeks gestation.

Maternity Units

19 sites reported that they have a Maternity Unit, with at least one Maternity Unit in each Health Board area.

All Maternity Units are open 24 hours a day, seven days a week. The exception is Inverclyde Royal Hospital in NHS Greater Glasgow and Clyde, where they reported that they have a Maternity unit that is open 08:00-20:00, seven days a week (Table 6). Outside of these hours, care is available on call or at the Royal Alexandra Hospital.

Community Maternity Units

21 sites reported that they have a Community Maternity Unit (CMU), these are in 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.

In NHS Dumfries and Galloway, Galloway Community Hospital operates a community maternity hub which is open 9:00-17:00 seven days a week for antenatal and postnatal appointments only.

Obstetrics and Gynaecology

21 sites said they had an Obstetrics and Gynaecology department. This is across all 14 Health Board areas as detailed in Table 8 below.

Most Obstetrics and Gynaecology departments are open 24 hours a day, seven days a week. However, in NHS Greater Glasgow and Clyde, Inverclyde Royal Hospital reported that they have an Obstetrics and Gynaecology department that is open 09:00-17:00 Monday-Friday for obstetric outreach clinics and antenatal appointments and closed on Saturdays and Sundays. In NHS Tayside, 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. In NHS Lanarkshire, the Obstetrics and Gynaecology department at University Hospital Wishaw is open 24 hours a day seven days a week, while the department at University Hospital Hairmyres only delivers outpatient services and is open 09:00-17:00 Monday-Friday and closed on Saturdays and Sundays.

Recurrent miscarriage services

The Lancet series states that 'as recurrent miscarriage is a sentinel marker for various obstetric risks in future pregnancies, women should receive care in preconception and obstetric clinics specialising in patients at high risk'.

13 sites said they have recurrent miscarriage services. This is across 11 Health Board areas.

The timing of recurrent miscarriage clinics varies across Scotland. However, no recurrent miscarriage services are available at weekends or out with 09:00-17:00 during weekdays Monday to Friday.

Infertility Services

14 sites said they have infertility services. This is across 12 Health Board areas.

The timing of infertility clinics varies across Scotland. However, no infertility services are available at weekends or out with 09:00-17:00 during weekdays Monday to Friday.

Accident and Emergency

Of the 44 sites included in this scoping exercise, 38 sites said that they have an Accident and Emergency (A&E) department. All 38 sites that have an A&E department reported that they are open 24 hours every day including weekends. There is at least one A&E department in every Health Board area.

Four sites reported that they have no maternity services and were identified as A&E only sites. One A&E only site said women experiencing miscarriage do present at their site. The other three A&E only sites said women do not present at their site but would present at a GP surgery, to midwifery teams or at another local hospital.

Out of Hours Care

If a woman presents at A&E in Scotland with suspected miscarriage through the night (out of hours) the pathway of care varies both within and between Health Boards. All sites triage patients and determine if the patient requires further investigation. This can involve liaison with obstetrics and gynaecology teams. If the patient is stable, they may be sent home and referred to early pregnancy services within the Health Board area. If the patient is not stable, they are generally transferred to obstetrics and gynaecology departments or maternity units for further investigation or to be admitted. In some cases women can be transferred to another site.