AQW 24657/17-22
Ms Paula Bradshaw
Alliance Party
South Belfast
Tabled Date: 20/10/2021
Answered On Date: 09/11/2021
Priority Written: No
Question:
To ask the Minister of Health to outline the timescale under which (i) a standardised pathway for post-miscarriage support and care will be established; and (ii) a pathway for specific personalised pathways for higher risk women will be put in place.
Answer:
There is already a regional pathway for recurrent pregnancy loss which was issued in 2020. There are guidelines for when testing should be carried out, and each Trust has a bereavement midwife in place. New draft guidelines on miscarriage have recently been published by the Royal College of Obstetricians and Gynaecologists (RCOG), will be reviewed by the HSCB and PHA. Subject to capacity within Health and Social Care, the local recurrent pregnancy loss pathway is due to be reviewed in 2022 and that review will take account of the finalised RCOG guidelines at that time. Furthermore, the current Maternity Strategy for Northern Ireland ran until 2018, and my Department has acknowledged the need to review maternity and neonatal services as part of the development of a new strategy. This will offer a good opportunity to take a comprehensive overview of what is currently offered and what is still needed to support and care for women who have sadly experienced miscarriage. I had agreed the terms of reference for a new review in early 2020; however, in the context of the need to prioritise the response to COVID-19, this work was paused in March 2020. I anticipate that my officials will pick up this work again as soon as possible in the New Year, subject to the prevailing pandemic pressures. My Department has endorsed the following guidance from the National Institute for Health and Care Excellence relating to higher risk pregnancy: Ref | Title | Date endorsed by DoH | NG3 | Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period | May 2015 | NG25 | Preterm labour and birth | Jan 2016 | NG121 | Intrapartum care for women with existing medical conditions or obstetric complications and their babies | April 2019 | NG126 | Ectopic pregnancy and miscarriage: diagnosis and initial management | June 2019 | NG133 | Hypertension in pregnancy: diagnosis and management | Aug 2019 | NG137 | Twin and triplet pregnancy | Nov 2019 | NG192 | Caesarean section | Oct 2021 |
Women are risk assessed at the booking appointment both for specific risk factors and also for the type of care they will require during their pregnancy. The risk assessment will continue at subsequent antenatal appointments to ensure they are on the correct care pathway. Where risks are identified, they will be managed as part of the antenatal care pathway and, where appropriate, other health and social care professionals will be involved. Women with long term conditions or multiple vulnerabilities may require additional pre-conception support and guidance depending on their condition/s. Often this can be provided as part of the ongoing management and care of their particular condition to help ensure the best outcomes for mother and baby. Sometimes this support will be incorporated into their routine care and in other circumstances, a dedicated service will be made available. For example, each of the Trusts has a pre-pregnancy service for women with diabetes to optimise health before pregnancy. For those women with a history of perinatal mental health issues, the new specialist perinatal mental health teams will offer additional advice and support to those women planning a pregnancy. The nature of support and guidance will vary depending on the individual circumstances of the woman.
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