Abstract

We evaluated recurrent miscarriage (RM) service provision in the 19 Irish maternity units/hospitals against guideline-based key performance indicators (KPIs) we previously developed during a multi-stage consensus process with key stakeholders. We invited Clinical Leads for pregnancy loss, Doctors-in-training, Clinical Nurse/Midwife Specialists and Directors of Midwifery within each unit/hospital to complete an online survey on behalf of their service between November 2021 and February 2022. We only required one response per unit/hospital. The survey comprised predominantly multiple choice questions concerning the KPIs, covering five categories: (i) structure of care, (ii) investigations, (iii) treatments, (iv) counselling and supportive care, and (v) outcomes. 18/19 units/hospitals completed the survey (95% response rate). While we identified some good practice, there was considerable variation - most obvious in areas such as: (1) referral criteria (provisions regarding the number of miscarriages or maternal age and number of living children); (2) location of clinics; (3) genetic counselling; (4) recording of subsequent pregnancy-related outcomes. A national guideline for RM is required. There needs to be adequate resourcing of services to implement recommendations, as well as systems for recording pregnancy outcomes and provisions for a national audit of RM care.