Ectopic pregnancy and miscarriage improvements needed
NICE recommends dedicated NHS service for women with a suspected miscarriage or ectopic pregnancy in England and Wales
12th December 2012 - The NHS should consider setting up dedicated services for pregnant women who may have an ectopic pregnancy or who experience pain or bleeding in their first trimester. The advice comes in a new guideline published by the National Institute for Health and Clinical Excellence (NICE).
While the majority of pregnancies progress successfully, around one in five will result in a miscarriage. Ectopic pregnancies (when the fertilised egg lodges and begins to develop in the fallopian tube rather than the uterus) occur in 11 out of every 1,000 pregnancies.
In England during 2010-11, a total of 54,162 women had either a miscarriage or an ectopic pregnancy which resulted in an NHS hospital stay.
Professor Mark Baker, Director of the Centre for Clinical Practice at NICE, said in a press release: "It can be very distressing and, in some cases, frightening to experience a miscarriage or be told your pregnancy is ectopic. It's vital that women and their families receive good, consistent, timely and effective care and support that addresses their needs and enables them to make informed decisions.
"We know that not every woman is receiving this level of treatment at the moment but this guideline will address that inconsistency and ensure all women receive excellent care, no matter where they live."
Seven day specialist service
The NICE guideline recommends regional services should be organised so that an early pregnancy assessment service is available seven days a week. Women with early pregnancy complications could be seen there, scans carried out and decisions made about how their pregnancy should be managed.
Professor Mary Ann Lumsden, professor of gynaecology and medical education at Glasgow University helped develop the guideline. In a press statement she said: "Some areas will already have dedicated early pregnancy assessment services but in those localities that do not, it is likely that a reorganisation of current resources will be all that is necessary.
"There may be some cost involved in setting up a seven-day specialist service but, in the long term, it is likely to be cheaper and is certainly better for the woman to have scan facilities and staff with the expertise to assess a woman than it is to treat her in theatre or on a hospital ward after she has collapsed from an ectopic pregnancy or excessive bleeding."
The Royal College of Midwives has welcomed the NICE guidelines and says it looks forward to their widespread implementation. Jane Munro, quality & audit professional advisor at the RCM said the guidelines would help ensure standardised and consistent care for women: "Women experiencing pain and bleeding in early pregnancy need to be able to access help and support seven days a week."
Between 2006 and 2008, there were 35,495 confirmed ectopic pregnancies and six women died during their first trimester as a direct result of their pregnancy. About two-thirds of deaths caused by ectopic pregnancy are associated with substandard care, due to missed or late diagnosis.