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Hum. Reprod. Advance Access originally published online on January 11, 2005
Human Reproduction 2005 20(2):531-535; doi:10.1093/humrep/deh617
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Human Reproduction vol. 20 no. 2 © European Society of Human Reproduction and Embryology 2004; all rights reserved

Are national recommendations regarding examination and disposal of products of miscarriage being followed? A need for revised guidelines?

Martin J. Cameron1,3 and Gillian C. Penney2

1 Department of Obstetrics & Gynaecology, Sunderland Royal Hospital, Kayll Road, Sunderland, SR4 7PT and 2 Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Cornhill Road, Aberdeen, AB25 2ZD, UK

3 To whom correspondence should be addressed at: Department of Obstetrics & Gynaecology, Sunderland Royal Hospital, Kayll Road, Sunderland, SR4 7PT, UK. Email: m.j.cameron{at}abdn.ac.uk

BACKGROUND: National guidance documents advise that tissue obtained from treatment of miscarriage should be submitted for histological examination to exclude trophoblastic disease and ectopic pregnancy, and require sensitive disposal of human tissue. The aim of this study was to determine the extent to which health professionals have adopted these recommendations. METHODS and RESULTS: Fifteen Scottish Obstetric and Gynaecology services participated in an audit of early pregnancy loss care. Three audit tools were used. In a case note review, 484 women completed medical or surgical treatment for miscarriage. 71% of records contained evidence of histological examination of tissue. Documentation of discussion of disposal of tissue with the woman was found in 29% of records. In a patient survey, 648 women with threatened or confirmed miscarriage returned questionnaires. Active treatment occurred in 134 cases. Only 55%, 50.9% and 47.4% reported being ‘informed’, ‘consented’ and ‘involved’, respectively, with decisions about tissue disposal. In a staff survey, a postal questionnaire was administered to 224 gynaecologists, with 144 replies. Self reported practice as ‘seldom’ or ‘occasional’ for sending tissue for histological examination was 34% for surgical evacuation and 57% for medical management. Reporting of ‘seldom’ or ‘occasional’ discussion of disposal of tissue with the woman was 42% and 49% for surgical and medical treatment, respectively. CONCLUSIONS: National guidance on these issues was found to be contentious and implementation was variable. Wide consultation with stakeholders is needed prior to the publication of revised guidance.

Key words: clinical guidelines/miscarriage/pathology/quality of care


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