Why don't we talk about pregnancy loss?

In 2021...

  • 357 babies were stillborn or died during the first 28 days of life [1]
    • 119 early neonatal deaths (0-7 days)
    • 238 stillbirths
  • 7% of stillbirths - cause of death was unknown [1]
  • Irish Traveller, Asian and Black ethnicities overrepresented in perinatal deaths (12.1% v 5%) [1]. Assessment of risk of perinatal loss associated with ethnic group is impeded by the absence of national data on ethnicity for the pregnant population
  • Ireland is one of a few countries with a National Perinatal Mortality Audit… However, miscarriages are not recorded at a national level
  • Molar pregnancy: 1 in 600 pregnancies [2]. Registration with the National GTD Registry is not compulsory
  • 865 ectopic pregnancies [3]
  • Increase in perinatal mortality (nos. of stillbirths and early neonatal deaths) since 2018. This follows decreasing rates in the decade prior to 2012, and a period of levelling off. In 2021, a slight decrease in perinatal mortality was observed [1]
  • True incidence of early pregnancy losses likely to be considerably higher, as some women will be treated as outpatients, or may not be managed in hospital, while others may not present to healthcare services at all [4]

Lack of public awareness and discussion

  • Less than 30% of people in a national survey were aware of the incidence of first trimester miscarriage [5]
  • 17% aware of the incidence of stillbirth [6]
  • 56% unable to identify any stillbirth risk factors [6]
  • 78% unaware of molar pregnancy prior to their diagnosis [7]

Poor care experiences

  • 24% of people rated their overall recurrent miscarriage care experience as poor [8]
  • 36% said the recurrent miscarriage care they received was much worse than expected [8]
  • 26% of people who experienced a second trimester miscarriage, a stillbirth or an early neonatal death rated their care as ‘fair to poor’ [9]
  • Consistent communication needed in services highlighted in the Maternity Bereavement Experience Survey [9]

Need for staff education and training

  • 60% stated healthcare professionals involved in recurrent miscarriage care in different places did not work well together [8]
  • 50% of healthcare professionals correctly identified the Irish definition of stillbirth [10]
  • 65% of healthcare professionals considered informing women regarding health behaviours & stillbirth risks to be part of their role [10]

Fear of litigation

  • 82% perceived media to have a role in propagating trainee doctors’ fears of litigation and adverse outcomes [11]
  • €2.4 billion paid to maternity services negligence claims; some of which relate to potentially avoidable perinatal deaths [12]

Need for staff supports

  • Healthcare professionals who were involved in an intrapartum death.....
    • 82% received no training in dealing with intrapartum death [13]
    • 94% had no education on self-care strategies [13]
    • Only 11% were offered debriefing [13]

Despite these statistics, and advocacy efforts, there is still

  • No routine data on first trimester miscarriage, ectopic pregnancy or molar pregnancy
  • No updated definition of perinatal mortality
  • No national care bundle for stillbirths
  • No national strategy for pregnancy loss
  • No confidential inquiry - hinders understanding and solutions
  • Very little mention of pregnancy loss in Government or national policy reports or HSE service plans

Pregnancy Loss Research Group

Pregnancy Loss Research Group, Department of Obstetrics & Gynaecology, University College Cork, Fifth Floor, Cork University Maternity Hospital, Wilton, Cork, T12 YE02, Ireland,