Improving Care for Pregnancy Loss <23 Weeks

Ensure every woman experiencing pregnancy loss before 23 weeks receives the appropriate, individualised and timely care and support - beginning with the first miscarriage and following a graded approach with more investigations for any subsequent miscarriages.

Graded Model of Care

Women who experience miscarriage should receive standardised, high-quality care across all maternity units. People should be guided to information and support about miscarriage, resources to meet their physical and mental health needs following pregnancy loss, and ways to optimise their health for any future pregnancy.

All women who experience a miscarriage should be offered a defined minimum set of care, in line with the National Clinical Practice Guideline: First Trimester Miscarriage.

For those who experience recurrent miscarriages, additional investigations and care should be provided as per the National Clinical Practice Guideline: Recurrent Miscarriage Clinical Guideline, and they should be offered appropriate, individualised, timely and accessible care and support - beginning following the first miscarriage and following a graded approach.

Implement routine national clinical data collection and reporting for pregnancy losses

We do not know how many pregnancies end in miscarriage as clinical data is not recorded nationally in primary or secondary care. Without data the scale of the problem is unknown, making it difficult to plan services and supports. Although, some hospitals report miscarriages in their annual reports, miscarriages are not recorded and/or reported at every maternity unit or at the community (GP) level.

Note that clinical data collection is not a registry and would not be linked to the issuing of a certificate. It is required to understand prevalence, trends, improve care and contribute to research on maternal demographics such as risk factors, geographic and socioeconomic factors.

By collecting national clinical data on miscarriages, we can achieve necessary visibility into the issue's scale and trends, establish accountability for improving care and services, and drive systemic change through informed planning and research.

Miscarriage & Early Pregnancy Loss Midwife

The Miscarriage and Early Pregnancy Loss Midwife provides comprehensive, advanced clinical care and emotional support to women and families experiencing early pregnancy loss. Responsibilities include patient triage and management across the Emergency Department, Early Pregnancy Unit, and wards; performing early pregnancy scanning; developing treatment plans and holistic midwifery care plans; prescribing medications; facilitating timely referrals for recurrent miscarriage, bereavement, and mental health services; supporting safe discharge and GP notification; and partnering with a consultant in agreed collaborations for shared decision-making and care. The midwife educates staff on miscarriage management, contributes to and leads research initiatives, conduct audits and implements improvements based on audit results, and champions the implementation of Recurrent Miscarriage (RM) and Bereavement Care Standards. Furthermore, the role requires maintenance of activity logs and service data, leading quality improvement initiatives, and actively seeking and managing patient experience feedback to ensure the highest standards of care are met.

A pilot scheme has funded dedicated midwives in Cork University Maternity Hospital, the Rotunda, the Coombe, University Hospital Galway and Sligo University Hospital, with the role filled and in operation in Cork University Maternity Hospital.

Dissemination, Engagement and Implementation of National Clinical Guidelines

The National Clinical Guidelines are a programme of work agreed between the National Women and Infants Health Programme and the Institute of Obstetricians and Gynaecologists of the Royal College of Physicians in Ireland structured support for implementation across the 19 maternity sites.

Clinical guidelines for first trimester, ectopic, and recurrent miscarriage already exist; however, adherence is currently unknown. A dedicated clinical guideline implementation lead is required support the National Women and Infants Health Programme to monitor and evalute implementation across the all matnerity units. The implementaiton lead would support dissemation and engagement across all matnerity units in partnership with site champions. Furthermore, the lead would systematically assess across all maternity units which recommendations have been implemented, identify any barriers to implementation, and establish either a clear path to implementation or document why a specific recommendation cannot be followed. Thereby ensuring standardised, high-quality care across all units and any divergences understood and documented.

Pregnancy Loss Information Booklets

Developed by the Pregnancy Loss Research Group, the booklets provides access to essential medical information and emotional support resources. The booklet offers comprehensive, sensitive guidance on first-trimester miscarriage, covering types of loss, management options (conservative, medical, surgical), physical aftercare, emotional impact, and dedicated support contacts. All women experiencing a miscarriage in the first weeks of pregnancy, an ectopic pregnancy or a recurrent miscarriage should be provided with a printed booklet from their healthcare professional.

Page updated

Google Sites

Report abuse