MISCARRIAGE SUPPORTS WORLDWIDE must be improved through better diagnosis, enhanced treatments and greater supports for women and their partners, a team of researchers in the UK has found.
The current “fragmented” approach to the treatment and care of miscarriage – which affects an estimated 15% of all pregnancies – “is inconsistent and poorly organised worldwide”, according to a three-paper report published in The Lancet medical journal today.
“A new system is needed to ensure miscarriages are better recognised and women are given the physical and mental health care they need,” the report notes.
The authors of the report recommend at least a minimum service to all women who have had a miscarriage – with increasing care for recurrent miscarriages – be offered globally, including testing, treatment, pre-pregnancy counselling and psychological support.
Co-lead author of the report, Professor Siobhan Quenby from the University of Warwick and the Deputy Director of Tommy’s National Centre for Miscarriage Research, UK, said “Many women have concerns over the unsympathetic care they receive following a miscarriage – with some not being offered any explanation, and the only advice they receive being to try again. This is not good enough, and we must ensure women are properly supported.”
“Although miscarriage is a one-time occurrence for most women, a significant portion of the population will require treatment and support,” said Professor Quenby.
“Yet silence around miscarriage remains not only for women who experience miscarriage but also among healthcare providers, policymakers, and research funders.
“We urge all countries to develop and provide more comprehensive miscarriage care services based on our recommendations, as well as improving research into miscarriage prevention, identifying women at high risk of physical and psychological after-effects, and screening for mental health issues after pregnancy loss.”
Today’s report found that approximately 23 million miscarriages occur every year globally but that the numbers could be higher because many miscarriages are managed at home and go unreported or unrecognised.
In addition, the report found that miscarriages can be associated with obstetric complications in future pregnancies and that the mental health impact of recurrent miscarriage – which affects an estimated 1% of women – is rarely acknowledged or addressed in medical care.
The reports calls for accurate diagnosis through effective and high-quality ultrasound services, and for women to be offered guidance on the range of ways for their miscarriage to be managed.
After a first miscarriage, the authors recommend that women be provided with information about miscarriage and physical and mental health needs, as well as health guidance to support future pregnancy.
Following a second miscarriage, women should be offered an appointment at a miscarriage clinic for full blood count and thyroid function tests, as well as a discussion of their risk factors.
After three miscarriages, additional tests and treatments should be offered under the care of a medical consultant. Genetic testing of pregnancy tissue should be offered, as well as pelvic ultrasound and, if necessary, parental genetic testing.
Today’s report also notes there is an evidence gap on miscarriage prevalence, consequences, and costs in low- and middle-income countries that must be addressed.
“The authors stress the need for better data collection, with few countries reporting an annual miscarriage rate, which makes international comparisons difficult.”
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