More miscarriage units needed in hospìtals and an urgent need to inform couples and the general public

A recent series from The Lancet  (March 26) addresses the medical and economical aspects of miscarriage ( read the series of 3 papers HERE). The bioethical interest of these studies is that miscarriage affects 1 in 10 women in their lifetime, with approximately 23 million miscarriages worldwide per year, corresponding to around 44 pregnancy losses every minute. The article says that “Despite this, the impact and consequences of miscarriage are underestimated, resulting in an attitude of acceptance of miscarriage and system of care which is currently fragmented and can be of poor quality [in this area].”

We excerpt what we believe is of more interest from a bioethical perspective, “The physical and psychological effect of miscarriage is commonly underappreciated. The journey from diagnosis of miscarriage, through clinical management, to supportive aftercare can be challenging for women, their partners, and caregivers. Diagnostic challenges can lead to delayed or ineffective care and increased anxiety. Inaccurate diagnosis of a miscarriage can result in the unintended termination of a wanted pregnancy. Uncertainty about the therapeutic effects of interventions can lead to suboptimal care, with variations across facilities and countries”.  The authors conclude their study with these recommendations: “We urge healthcare funders and providers to invest in early pregnancy care, with specific focus on training for clinical nurse specialists and doctors to provide comprehensive miscarriage care within the setting of dedicated early pregnancy units”.

The study also discusses the global need for early miscarriage units “The availability and accessibility of services for the diagnosis and management of miscarriage vary greatly worldwide. Emergency early pregnancy care is provided in more than 200 dedicated early pregnancy units in the UK. Similar units have now been established in many other countries, including the Netherlands, Canada, Ireland, and Australia. In the USA, the first early pregnancy unit was established in Denver (CO) in 2013 (Read Sporadic miscarriage: evidence to provide effective care).

In this respect, we published a review that concluded “[…] that a correlation could be established between abortions (both miscarriages and TOP) and an increased risk of death or onset of certain disorders in the women analyzed. Furthermore, this risk seemed to depend on the number of losses: it was significantly higher in those women who had had two or more losses in previous pregnancies.” (read HERE full article)

Miscarriage units needed to reduce high early mortality and the related risk of mothers’ death

In the opinion of our Observatory, misconceptions such as the belief that miscarriage is rare, that it can be caused by lifting heavy objects or previous contraceptive use, or that there are no effective treatments to prevent miscarriage, hurt women and their partners, leaving them feeling at fault not seeking treatment and support. It is urgent to provide these couples and the fertile population with accurate information explaining the current availability of effective treatments.