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 Rosinder Kaur, Dr Adam Devall, Dr Pedro Melo, Dr Justin Chu, Dr Natalie Woodhead, Professor Siobhan Quenby, Professor Tom Bourne, Rajinder Kaur

    Start date: 2021

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 great variation in the quality and type of care that is offered to women and birthing people 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 or birthing person has suffered three losses. This can leave families 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?

In April 2021, our researchers 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 and birthing people 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 have developed 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, with 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, which will help women, birthing people and their partners know what they should be offered, empowering them to make sure they are receiving the right care. The team are now preparing to test the National Miscarriage Care Package at Birmingham Women’s Hospital, and want to find out whether it needs adapting before it is rolled out nationwide.

While carrying out this work, our researchers also realised that better psychological screening and support is needed for women and birthing people who have suffered miscarriage. As a result, our team are developing an evidence-based screening tool that can identify the women and birthing people who need to be referred to self-help resources or relevant specialist mental health services.

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, birthing people and their partners to advocate for themselves and receive the best possible care.