The care that women receive following a miscarriage during the second trimester of pregnancy varies according to where in the UK and Ireland the woman is treated, new research shows.
The study, led by the University of Aberdeen in collaboration with colleagues from the University of Manchester, University College Cork and University of Birmingham, was funded by Tommy's, the pregnancy and baby charity, and published in The European Journal of Obstetrics & Gynaecology and Reproductive Biology.
Led by Dr Andrea Woolner, Senior Clinical Lecturer at the University of Aberdeen and Honorary Consultant Obstetrician & Early Pregnancy Lead at NHS Grampian, the team looked at survey responses from 116 healthcare professionals working in maternity services in the UK and Ireland.
Second trimester pregnancy loss (STPL) usually refers to pregnancy loss, or miscarriage after 12 or 13 weeks' gestation. It is estimated to occur in around 3 to 4% of pregnancies. However, this study showed the definition used to describe STPL in healthcare settings varies considerably within the UK and Ireland.
Findings revealed that there is inconsistency and uncertainty around medications used following second trimester pregnancy loss (STPL), which the authors state reflects the lack of research into this devastating type of loss.
For example, almost two thirds of healthcare professionals surveyed (63%) acknowledged they were uncertain about the optimal dosage of misoprostol - a drug that can be given following STPL to induce birth - that should be used, likely due to a lack of research in this area, according to the authors.
Researchers also found that care was given in different hospital wards and not always within maternity settings in different parts of the UK and Ireland. The authors say this highlights the need to consider how hospitals are set up for couples experiencing STPL, and to consider what the optimal referral pathways and infrastructure needs are. The team intends to carry out further research exploring views of those with lived experience of STPL.
Following treatment in hospital, fewer than half (45%) of respondents reported that follow-up appointments took place in a dedicated pregnancy loss clinic. Many women were offered follow up in preterm birth clinics, though the research team notes this wasn't always universal either as not every STPL involves a preterm labour.
There is a growing body of evidence that shows structured care in a dedicated pregnancy loss clinic is the best option for couples who have experienced a stillbirth (when a baby sadly dies after 24 weeks of pregnancy), and researchers say the findings of the study underline the inconsistencies faced by families who lose a baby at different stages of pregnancy.
They also noted there was variation in the investigations and care offered in the next pregnancy after a second trimester loss.
Researchers say more work is needed to understand what the best treatments are and what universal provisions should be made for couples facing the devastation of second trimester pregnancy loss
The team is planning to gain insight from those with lived experience, with the aim of developing a clear view of what is needed to improve care for the future and understanding what research is needed urgently to address these gaps.
Dr Andrea Woolner said: "Pregnancy loss at any stage is devastating. This study showed that there is a lack of research and evidence-based clinical practice around STPL in particular.
"In this survey, we wanted to hear from the people on the ground who work with bereaved parents, to find out exactly where the disparities lie from a healthcare professional perspective and what we need to do to improve things.
"Our findings highlight the lack of standardised care - this is important because we know that pregnancy loss at any stage of pregnancy has a profound impact on couples and on their next pregnancies.
"Ensuring that evidence-based and universal recommendations for birth, bereavement and future antenatal care are offered to all couples after pregnancy loss is vital, and akin to the recommendations for care after stillbirth, we hope that this work highlights clinicians, policy-makers and researchers need to also focus on care for second trimester pregnancy loss.
Professor Alex Heazell, one of the co-authors from the University of Manchester and Director of Tommy's Maternal and Fetal Health Research Centre in Manchester, said: "This work aligns with a previous multi-hospital audit published in 2024 which showed fragmented and inconsistent care provisions but also highlighted the number of women who present to hospital in the second trimester with various symptoms including those that may be a sign of pregnancy loss.
"We urgently need better quality data to help us provide the best care."
Dr Jyotsna Vohra, Director of Research, Programmes and Impact at Tommy's, said: "Losing a baby is devastating at any stage of pregnancy. When the loss happens after 12 weeks - the stage at which people are often encouraged to believe they are 'safe' - it can be particularly traumatic for women and families.
"This study shows we need more research and better standardised care across the NHS so that anyone experiencing symptoms of loss at any stage of pregnancy knows they will receive the most effective care, treatment and support."
