Recent research highlights significant disparities in the care provided to women experiencing second trimester pregnancy loss (STPL) across the UK and Ireland. A study led by the University of Aberdeen and conducted in collaboration with the University of Manchester, University College Cork, and University of Birmingham, reveals that the quality of care varies dramatically depending on geographical location. Funded by Tommy’s, a prominent pregnancy and baby charity, the findings were published in The European Journal of Obstetrics & Gynaecology and Reproductive Biology.
Dr. Andrea Woolner, a Senior Clinical Lecturer at the University of Aberdeen and Honorary Consultant Obstetrician at NHS Grampian, led the research, which analyzed survey responses from 116 healthcare professionals in maternity services across the two regions. The study underscores that STPL, which typically refers to miscarriage occurring after 12 or 13 weeks’ gestation, affects approximately 3 to 4% of pregnancies. However, definitions and care protocols surrounding STPL are inconsistent.
The research identified a notable lack of clarity regarding medications used post-miscarriage. Almost two-thirds of surveyed healthcare professionals (63%) expressed uncertainty about the optimal dosage of misoprostol, a medication often administered to induce birth following STPL. This uncertainty reflects an urgent need for further research into the management of this profound loss.
Inconsistencies in Care and Follow-Up
Findings also revealed that the care provided varies significantly across hospital wards, with not all treatments available in maternity settings. The authors advocate for a reassessment of hospital infrastructures to ensure that couples facing STPL receive appropriate care and support. After hospital treatment, fewer than half (45%) of respondents reported that follow-up appointments were conducted in dedicated pregnancy loss clinics. Instead, many women were referred to preterm birth clinics, an approach that is inconsistent since not all STPL cases involve premature labor.
The study reinforces the growing consensus that specialized care in dedicated pregnancy loss clinics offers the best support for families who have suffered stillbirth, defined as the loss of a baby after 24 weeks of pregnancy. Variability in care and follow-up investigations for subsequent pregnancies after a second trimester loss was also noted, emphasizing the need for standardization in treatment protocols.
Dr. Woolner remarked, “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.” She highlighted the importance of understanding the healthcare professionals’ perspectives to identify disparities in care and improve outcomes for bereaved parents.
Call for Improved Standards and Research
Prof. Alex Heazell, co-author from the University of Manchester and Director of Tommy’s Maternal and Fetal Health Research Centre, added that this research aligns with a previous audit published in 2024, which also found fragmented care provisions. He emphasized the need for better data to enhance care for women presenting with symptoms suggestive of pregnancy loss.
Dr. Jyotsna Vohra, Director of Research at Tommy’s, reinforced the emotional toll of losing a baby, particularly after 12 weeks, when many expectant parents feel a sense of security. “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,” she stated.
The research team plans to conduct further studies to gather insights from individuals with lived experiences of STPL, aiming to develop a comprehensive understanding of the care needed to support families during such a difficult time. As the conversation around pregnancy loss continues, the authors hope their findings will prompt healthcare professionals, policymakers, and researchers to prioritize consistent, evidence-based care for families affected by second trimester pregnancy loss.
