New research reveals significant variation in care for second trimester pregnancy loss across the UK and Ireland, with inconsistent treatment pathways and support, underscoring the need for standardised clinical guidelines
The research shows women experiencing baby loss in the second trimester receive different care depending on location in the UK and Ireland.
The study, led by a team including the University of Manchester and funded by Tommy’s charity, found wide variation in clinical practices, medication use, follow-up support and hospital settings, highlighting a postcode lottery in a deeply traumatic stage of pregnancy loss. Researchers urge immediate, coordinated action to standardise care and establish clear pathways, ensuring equitable support and treatment for all families.
The full study is published in The European Journal of Obstetrics & Gynaecology and Reproductive Biology.
63% of healthcare professionals reported being uncertain about what doses of misoprostol to use after second trimester pregnancy loss.
Second trimester pregnancy loss (STPL) refers to pregnancy loss or miscarriage occurring after 12 or 13 weeks’ gestation, and this affects approximately 3% to 4% of pregnancies, according to the surveyed respondents.
The researchers, led by Dr Andrea Woolner, Senior Clinical Lecturer at the University of Aberdeen and Honorary Consultant Obstetrician & Early Pregnancy Lead at NHS Grampian, looked at survey responses from 116 healthcare professionals working in maternity services in the UK and Ireland.
The survey 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 second trimester pregnancy loss to induce birth – that should be used, likely due to a lack of research in this area, according to the authors.
Second trimester pregnancy loss and postcode lottery
The researchers found that the hospital care parents received varied greatly across different parts of the UK and Ireland. For example, some parents were given care in different hospital wards and not always within maternity settings.
Furthermore, after hospital treatment, 45% of respondents reported that follow-up appointments occurred 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 second term pregnancy loss involves preterm labour.
A growing body of evidence shows that structured care in a dedicated pregnancy loss clinic is the best option for couples who have experienced stillbirth, and researchers say the findings of the study underline the inconsistencies faced by families who lose a baby at different stages of pregnancy.
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 that clinicians, policy-makers, and researchers also need to focus on care for second trimester pregnancy loss.
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.”
