Abstract

There is a lack of research and published national or international guidelines on second trimester pregnancy loss. We conducted a survey of professionals working in maternity services in the UK and Ireland to find out (i) how second trimester pregnancy loss was managed within hospitals and (ii) future research priorities.

How second trimester pregnancy loss was defined varied, as did the location of care for the assessment and management of second trimester pregnancy loss. Two in five women could self-refer to hospitals for assessment in the second trimester. The amount (dose) of the medication, misoprostol, used for second trimester pregnancy loss varied between hospitals and three in five people who responded to the survey were unsure about the best dose to use. Surgical management was rarely offered. Although almost all hospitals reported consultant follow-up, but just under half of respondents reported routine follow up took place in a dedicated pregnancy loss clinic. Only about half of respondents reported that post-mortem examination (autopsy) was routinely offered after second trimester pregnancy loss. Respondents reported that antenatal care in the next pregnancy after a second trimester loss was provided in a specialist pregnancy loss clinic (31% of the time) or preterm birth clinic (43%).

Highlighted research priorities in the area of second trimester pregnancy loss included: optimising medical management for women with a scarred uterus (womb), medical methods to reduce the risk of retained placenta (afterbirth), investigations after second trimester pregnancy loss, and impacts on next pregnancies.

High quality research is needed to develop evidence-based clinical guidance to reduce the differences in care in second trimester pregnancy loss that were confirmed by this study.