A study suggests that routinely offering women further tests after their first miscarriage, rather than waiting until their third, could prevent more than 10,000 pregnancy losses annually in the UK. The additional measures are effective and can be implemented without significant extra workload for NHS teams, according to the pregnancy and baby charity Tommy's.
Current NHS Practice
Currently, the NHS typically runs tests after a third miscarriage. This leaves families unsupported and their grief unrecognised, a new report by Tommy's states.
The Graded Model of Care
The pilot study, conducted by researchers at Tommy's National Centre for Miscarriage Research and Birmingham Women's Hospital, trialled a graded model of miscarriage care. This involves earlier NHS intervention: after a first loss, women receive a one-to-one consultation with a specialist nurse to discuss preconception and prenatal health. The hormone progesterone may also be offered in future pregnancies if a woman experiences early vaginal bleeding.
After two miscarriages, patients would be offered tests for anaemia and abnormal thyroid function. If a third miscarriage occurs, women would receive the current standard NHS care.
Potential Impact
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.'
The trial included 203 women with a history of one or more miscarriages who received early intervention, and 203 who had usual care. Among those receiving the graded model, 86% had one or more factors detected that could increase their risk of future miscarriages, compared to 58% in the standard care group. Women in the graded model had a 4% lower risk of another miscarriage.
The measures could also save the NHS more than £40 million after one year, the report suggests.
Additional Findings
Among women who had two losses, one in five were found to have thyroid problems or anaemia, detected in blood tests they would not usually receive at that stage.
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. The three-miscarriage wait means women and families are left without early access to services that could help prevent future losses and reduce feelings of isolation and hopelessness. 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. Put simply, it is the right thing to do.'
Tommy's estimates there are about 250,000 miscarriages in the UK each year. Scotland has already embedded the new model into its miscarriage care pathway, and Ms Abrahams called on policymakers in England, Wales, and Northern Ireland to follow suit.
Government Response
The Government has pledged to review miscarriage support in the new Women's Health Strategy. Baroness Merron, parliamentary under-secretary of state at the Department of Health and Social Care, welcomed the study and said its findings 'will be carefully considered.' She added: 'Pregnancy and baby loss can have a devastating impact on women and families, who too often feel 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.'
