•Miscarriage is defined as ‘the spontaneous demise of a pregnancy in utero before the fetus reaches viability.’ This applies up to 23+6 weeks gestation in the UK.1

•Miscarriage is common and it is commonly cited that around 1 in 4 of all pregnancies will result in miscarriage.2 Therefore, miscarriage management is a significant aspect of women’s health as a whole and is likely to affect many women’s lives.

•Improving miscarriage services is of upmost importance in the field of women’s health and therefore results in the need for this audit of management of miscarriage at Watford Hospital.

Did WGH adhere to NICE guidelines in the diagnosis and management of miscarriage (1a+1b).

To look at rates and complications of the different management options at WGH for the benefit/ interest of the EPU locally. These rates were compared to national standards (2 + 3).

 

 

b. Women who are referred with suspected ectopic pregnancy or miscarriage are offered a transvaginal ultrasound scan to identify the location and viability of the pregnancy

 

2. Rate of retained products of conception (RPOC) post conservative management is 50%.

 

3. Rate of RPOC post medical management nationally is 15%3

4. The incidence of RPOC post surgical management (SMM) nationally is 4% and the incidence of requiring repeat SMM ranges from 0.3% to 1.8%4.

 

 

Data set: All patients seen in EPU diagnosed with a miscarriage between June and December 2022

 

Compared to NICE standards and national rates as detailed above.

1a: 82% got an appointment to be seen + USS within 24 hours of referral

 

1b: 100% offered an ultrasound scan

 

Expectant Management: 2.7% resulted in medical management and 5.5% resulted in surgical management.

 

Medical Management:

17% required repeat treatment for RPOC (12.8% - MMM and 4.3% - SMM)

 

Surgical Management:

No patients required repeat SMM.

1% - RPOC rate

 

A large proportion of patients referred to EPU were seen within 24 hours, however this is still below the NICE national standard of 100%. Looking at dates of referral/ appointment time shows that most of those who did not were due to the weekend or a backlog created by the weekend on a Monday.

All patients were offered a TVUS compliant with NICE standards.

Rates of repeat management were generally below national averages, apart from the success rate of medical management which was slightly below national rates.

Our figures are below the national figures for RPOC post-SMM (1%, nationally 4%) and also below national figures for repeat SMM required (0%, nationally 0.3%-1.8%).