Birmingham Women’s Hospital the site of pioneering miscarriage research
Our Women’s Hospital has been at the forefront of research trial that could help prevent more than 10,000 pregnancy losses every year.
Currently women can access tests and support only after a third miscarriage in most cases. Miscarriage charity, Tommy’s, has trialed a ‘graded model’ that offers care after every miscarriage, including the first. This creates earlier opportunities to support families devastated by loss and to identify treatable health issues and other risk factors that can affect pregnancy outcomes.
The pilot study, by researchers at Tommy’s National Centre for Miscarriage Research and Birmingham Women’s Hospital, found that women treated under the Graded Model of Miscarriage Care were more likely to have miscarriage risk factors and medical conditions identified than those who received the usual NHS care.
They also had a reduced likelihood of another miscarriage compared with the usual care group.
Professor Arri Coomarasamy OBE, 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.”
Under the Graded Model of Miscarriage Care, a specialist nurse provides a one-to-one consultation after a first loss to discuss optimising preconception and pregnancy health. The hormone progesterone, which a trial at Tommy’s National Centre for Miscarriage Research found to be effective in preventing some miscarriages, is offered in future pregnancies if a woman is experiencing early vaginal bleeding that signals she may be at risk of loss.
After two miscarriages, women are additionally offered tests for anaemia and abnormal thyroid function, both of which are treatable and can affect pregnancy outcomes. Early reassurance scans are offered in future pregnancies.
After three miscarriages, as well as the care provided after the first and second losses, women join the pathway offered usually by the NHS. They are referred to a recurrent miscarriage clinic overseen by a consultant and offered tests to look for ‘sticky blood’ syndrome (antiphospholipid syndrome, which increases the risk of blood clots and related pregnancy complications), possible genetic causes for their miscarriages and a pelvic ultrasound scan.
Of the women in the Graded Model of Miscarriage Care pilot group who had experienced two miscarriages, one in five were found to have either thyroid problems or anaemia (low iron), identified by a blood test they would not have had at that stage under standard NHS miscarriage care.
Other key findings from the pilot include:
99 per cent of women who took part said they were very satisfied or satisfied with their care
93 per cent of healthcare professionals involved said the graded model was straightforward to deliver
86 per cent of women who took part had one or more risk factors identified that could increase their risk of miscarriage and were given advice about changes they could make. This was compared with 58% in the usual care group.
Kath Abrahams, Chief Executive of Tommy’s, said: “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 who are already working extremely hard to deliver good care.
“Put simply, it is the right thing to do.
“We will do all we can to drive that change across the UK, so that more women and families are supported after every miscarriage.”
In the foreword to the report, Tommy’s Ambassador Myleene Klass MBE – who has shared her own experience of recurrent pregnancy loss and campaigned extensively for change - hails the Graded Model of Miscarriage Care as ‘a turning point’.
Describing it as ‘an honour’ to have met some of the parents who took part in the study and went on to have a baby, she says: “This is our moment to give every family that same lifechanging opportunity.”