Researchers call for investment and improvement in miscarriage care

Researchers from the University of Birmingham and Tommy’s National Centre for Miscarriage Research have called on the UK government to invest in early pregnancy units and recurrent miscarriage clinics.

Experts from those institutions have used research to highlight the variation in miscarriage care across the UK – which it is said can make services a ‘postcode lottery’.

The team from Birmingham recently published three papers on the subject of miscarriage in The Lancet – and set out recommendations for improved treatment for women in three categories: diagnosis of miscarriage, prevention of miscarriage in women with early pregnancy bleeding, and management of miscarriage.

According to the University of Birmingham, recommendations include:

  • Individualised care for women and their partners.
  • Early pregnancy services to provide an effective ultrasound service and miscarriage management pathway.
  • Prescribing vaginal micronized progesterone for pregnant women with the dual risk factors of early pregnancy bleeding and previous miscarriage.
  • Training for clinical nurse specialists and doctors to deliver comprehensive miscarriage care in dedicated early pregnancy units.
  • A ‘defined and universally available’ minimum set of investigations and treatments offered to couples suffering recurrent miscarriages.
  • Screening and care for mental health issues and future obstetric risks for couples with a history of recurrent miscarriages.
  • Structured care using a ‘graded model’ – offering women online healthcare advice and support, care in a nurse or midwife-led clinic, and care in a medical consultant-led clinic, according to clinical needs.

NHS policy over testing for the underlying causes of miscarriage are one of the areas of note, as these are only presently provided for women after three consecutive miscarriages. But Birmingham experts believe ‘risks related to a miscarriage are present even after one or two miscarriages’ and that care ‘should be provided to all women who have experienced one or more’ miscarriages.

It’s also highlighted that the UK does not currently provide national statistics for miscarriage – although it does for stillbirths and neonatal deaths.

The review also found 40% higher miscarriage rates for black women than their white counterparts, with further investigation required.

Senior research author Arri Coomarasamy, Professor of Gynaecology & Reproductive Medicine at the University of Birmingham and Director of Tommy’s, said: “Despite the many advances in miscarriage research and care, we are really just at the beginning, with many more avenues to investigate – for example, we need to understand why there is a higher rate of miscarriage in black women and why miscarriage is associated with an increased future risk of premature birth.

“We don’t even know exactly how many miscarriages happen in the UK; without this data, the scale of the problem is hidden, and addressing it will not be prioritised.

“As we work to open the ‘black box’ of miscarriage in the hope of unpicking its causes and finding new therapies, the UK must change its approach to miscarriage care, not only to reduce the risk wherever possible but also to better support those who do tragically lose their babies.”

Jane Brewin, CEO at Tommy’s, added: “We know what to do and how to do it – now we need a commitment from the NHS to put the knowledge we have into practice everywhere. With national targets to reduce premature birth and stillbirth, it’s time to prioritise miscarriage too.”