One in five pregnancies end in miscarriage and eleven in every thousand are ectopic – this is where the fetus develops outside the uterus and the pregnancy is not viable. The National Institute for Health and Clinical Excellence (NICE) has issued new guidelines and recommends that the NHS should develop specialist services for women at risk of miscarriage or ectopic pregnancy. These should be accessible every day of the week and a round the clock helpline should be available for women who experience bleeding or pain during the first three months of pregnancy. NICE believes that at present insufficient information is available and inadequate support given to women at risk of miscarriage and ectopic pregnancy. They also feel that doctors need to be more compassionate towards women whose pregnancies are threatened; all too often women are provided with information, but it is not acknowledged that they have received heartbreaking news.

Increased awareness

The aim of the new guidelines is to increase awareness and encourage doctors to consider whether a woman who is presenting with certain symptoms indicative of miscarriage or ectopic pregnancy could in fact be pregnant, as after all in the early stages a woman may not realise herself. Although there are only a handful of deaths from ectopic pregnancy each year – between 2006 and 2008 there were six – any deaths are more than necessary and are largely the result of inadequate care.

Costs and benefits

Stating a seven day a week service will inevitably involve financial investment, but this will be money well spent. It is more cost effective for women to have access to specialist advice and scan facilities than for them to need treatment on a ward or in an operating theatre after experiencing heavy bleeding or collapsing as a result of an ectopic pregnancy. The Department of Health is therefore strongly encouraging hospitals to implement these new guidelines, as pregnant women are entitled to the highest standards of care. Universal application of these guidelines will ensure that all women will receive high quality care no matter where in the country they live, as while currently some NHS trusts do a very good job of providing specialist services for women at risk of miscarriage and ectopic pregnancy, this cannot be said of everywhere. Another aim of the guidelines is to reduce inequalities further by improving access of care for those women who currently struggle to use such services, such as refugees, asylum seekers or other women who have recently moved to the UK.

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