Miscarriage support should be offered earlier, NHS study shows

Offering further tests as a matter of routine after a first miscarriage could prevent more than 10,000 pregnancy losses a year, a pilot study has suggested.

A new ‘graded model’ of miscarriage care would involve the NHS intervening at an earlier stage rather than following the current standard of waiting until a woman has had three miscarriages.

In a trial done at Tommy’s National Centre for Miscarriage Research and Birmingham Women’s Hospital, women were offered a one-to-one consultation with a specialist nurse after their first loss.

Under the approach, progesterone could be offered in future pregnancies if a woman has experienced early vaginal bleeding.

And after two miscarriages, patients would be offered tests for anaemia and abnormal thyroid function.

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After a third miscarriage, women would be offered the current standard NHS care, the team who developed the model said.

Results from 203 women with a history of one or more miscarriages who were given early intervention compared with the same number having usual care showed the graded approach was more likely to pick up risk factors.

Overall, 86% who had early intervention had one or more factors detected that could increase their risk of future miscarriages, compared to 58% in the group who had standard care.

Among women who had two losses, one in five were found to have either thyroid problems or anaemia that would not usually be identified at that point, they reported.

Women treated using the graded model had a 4% lower risk of a pregnancy after miscarriage ending in another loss, the team reported.

Calling for the approach to be adopted, Tommy’s said the government had committed to reviewing the results of the study as part of the Women’s Health Strategy.

Professor Arri Coomarasamy, director of Tommy’s National Centre for Miscarriage Research, said: ‘If the graded model were implemented across the UK, our study indicates it could prevent around 10,075 miscarriages every year.

‘That’s more than 10,000 families bringing their babies home instead of suffering the trauma of a pregnancy loss.’

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It was also calculated that should the approach be used more widely, it could also save the NHS more than £40m after one year.

Kath Abrahams, chief executive of Tommy’s, said: ‘NHS care and support for women who experience a miscarriage in the UK is inconsistent and generally involves no follow-up or tests until after a third loss.

‘Our pilot study indicates that providing support after a first miscarriage, with escalating care after further losses, is not only effective but achievable without significant additional workload for NHS teams who are already working extremely hard to deliver good care.’

Scotland has already embedded the new model into its miscarriage care pathway, she added.

Baroness Merron, parliamentary under-secretary of state at the Department of Health and Social Care, said the findings would be carefully considered.

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She added: ‘Pregnancy and baby loss can have a devastating impact on women and families, who too often feel they have been left without the care and support they need.

‘Research like this is crucial, and our renewed Women’s Health Strategy puts women’s voices and experiences at the heart of care.’

A version of this article was first published by our sister title Pulse