European journal of obstetrics, gynecology, and reproductive biology · 2025
Current management of second trimester pregnancy loss in the UK and Ireland: a survey of healthcare professionals.
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Woolner Andrea Mf, Linehan Laura, O'Donoghue Keelin, Kaur Rosinder, Heazell Alexander E P
Аннотация
BACKGROUND: Second trimester pregnancy loss (STPL) is under-researched. There are no published national or international guidelines. We hypothesised that the management of STPL varied across the UK and Ireland.
METHODS: A prospective cross-sectional survey was conducted as part of the PASTeL-3 project. An electronic online survey was live between 19th November 2024 and 7th March 2025. Professionals working in maternity services in the UK and Ireland were invited to participate the survey via social media and email.
FINDINGS: The definition of STPL varied between hospitals, with lack of consensus on the lower and upper gestational age limits. Care location for assessment and management of STPL differed between hospitals. 43 % of women could self-refer for assessment in the second trimester. Dosages of misoprostol used for STPL varied between hospitals from 50-400 µg, and 63 % of respondents reported uncertainty over the optimal dosage of misoprostol for STPL. Elective surgical management for STPL was rarely offered. Pharmacological management of the third stage of labour after STPL was largely based on oxytocics, with a minority using Misoprostol alone (10 %). Although almost all units reported consultant follow-up, only 45 % of respondents reported routine follow up took place in a dedicated pregnancy loss clinic. Only 52 % of respondents reported that post-mortem examination was routinely offered after STPL.
INTERPRETATION: There is confusion over the definitions, appropriate location for care, optimal therapeutic options and follow up needed following STPL. High quality research for STPL should be prioritised to develop evidence-based clinical guidance to reduce variation in care.
METHODS: A prospective cross-sectional survey was conducted as part of the PASTeL-3 project. An electronic online survey was live between 19th November 2024 and 7th March 2025. Professionals working in maternity services in the UK and Ireland were invited to participate the survey via social media and email.
FINDINGS: The definition of STPL varied between hospitals, with lack of consensus on the lower and upper gestational age limits. Care location for assessment and management of STPL differed between hospitals. 43 % of women could self-refer for assessment in the second trimester. Dosages of misoprostol used for STPL varied between hospitals from 50-400 µg, and 63 % of respondents reported uncertainty over the optimal dosage of misoprostol for STPL. Elective surgical management for STPL was rarely offered. Pharmacological management of the third stage of labour after STPL was largely based on oxytocics, with a minority using Misoprostol alone (10 %). Although almost all units reported consultant follow-up, only 45 % of respondents reported routine follow up took place in a dedicated pregnancy loss clinic. Only 52 % of respondents reported that post-mortem examination was routinely offered after STPL.
INTERPRETATION: There is confusion over the definitions, appropriate location for care, optimal therapeutic options and follow up needed following STPL. High quality research for STPL should be prioritised to develop evidence-based clinical guidance to reduce variation in care.