The National Miscarriage Care Package

Tommy’s researchers are developing a National Miscarriage Care Package that will provide guidelines to health professionals across the UK, helping to standardise care.
  • Authors list

    Professor Arri Coomarasamy, Dr Adam Devall, Dr Pedro Melo, Dr Justin Chu, Professor Siobhan Quenby, Professor Tom Bourne, Dr Maya Al Memar, Rajinder Kaur

Why do we need this research?

Around 1 in 5 women will have a miscarriage and approximately 1% of women experience recurrent miscarriage, defined as three or more miscarriages in a row. Across the UK, there is a large variation in the quality and type of care that is offered to women following a miscarriage, and there is a lack of certainty around which tests and treatments should be used. Often, the cause of miscarriage will only be investigated after a woman has suffered three losses. This can leave women and their partners unsure about the chances of miscarriage happening again, with some going to multiple doctors or clinics in their search for a cause and remedy for miscarriage.
We believe this must change.

What’s happening in this project?

Our researchers recently published a series of three articles in the prestigious medical journal, The Lancet. By combining all previously published research, the team laid bare the devastating impact of miscarriage and set out recommendations to improve treatment and care. For example, they found that miscarriage doubles the risk of depression and quadruples the risk of suicide, and that women who have had a previous miscarriage are more likely to experience complications in a subsequent pregnancy. 

As part of the Lancet miscarriage research series, our team looked at all previously published research that assessed the effectiveness of the tests and treatments that may be offered to women who have had a miscarriage. They also reviewed current clinical guidelines and met with women and healthcare professionals from around the UK to gain consensus on the care that should be provided. Based on these findings, our researchers are developing a National Miscarriage Care Package that will provide guidelines to health professionals across the UK, helping to standardise care. The care package calls for a graded approach, where women are offered online healthcare advice and screening after one miscarriage, care in a nurse or midwife-led clinic after two miscarriages, and care in a medical consultant-led clinic after three miscarriages. This approach balances the need for evidence-based management and supportive care, while targeting finite healthcare resources appropriately. Alongside the care package, the team are also developing commissioning guidelines and a patient’s charter. The patient’s charter will help women and their partners know what they should be offered, empowering them to make sure they are receiving the right care.

Our researchers will now pilot the National Miscarriage Care Package in a small number of NHS trusts to see how easily it can be introduced. By assessing the care package in selected NHS trusts, our team will be able to refine it if necessary before it is rolled out nationwide.

What difference will this project make?

The National Miscarriage Care Package will transform the treatment of recurrent miscarriage in the UK by providing clear, evidence-based clinical guidelines. The patient charter will help patients understand what they could reasonably expect from a recurrent miscarriage service, enabling women and their partners to advocate for themselves so that they receive the best possible care.