Doctors 'Must Be Sensitive To Women At Risk Of Miscarriage And Ectopic Pregnancy'

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Doctors must be more sympathetic to pregnant women in danger of losing their babies, according to a new report.

The National Institute for Health and Clinical Excellence (Nice) believes doctors do not give enough information or support to women at risk of miscarriages or ectopic pregnancies, where the egg will not develop into a baby.

Professor Mary Ann Lumsden, from Glasgow University, who helped develop the report, said: "It actually does not cost a great deal to be sympathetic and we try and get across that it is something that happens to a lot of women, but for each woman it is a unique event even if it happens more than once.

"We must recognise people's distress. We do recommend that staff are trained in dealing sensitively with giving information and that they get trained repeatedly."

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Dr Nicola Davies, a GP who also helped with the report, said: "As a junior doctor, seeing people bleeding in pregnancy every hour, we do become very hard to it and do not give people time."

According to Nice, one in five pregnancies results in a miscarriage and 11 out of 1,000 are ectopic, meaning there are more than 50,000 early pregnancy losses in the UK annually.

Between 2006 and 2008, six women died from ectopic pregnancies and two-thirds of those deaths were associated with sub-standard care.

The report recommends early pregnancy assessment services to try and diagnose ectopic pregnancies, which are frequently missed by doctors, and a 24-hour phone service.

It also emphasises the organisation of regional services so that there is help available seven days a week for women with early pregnancy complications, as in some areas there are no weekend or out-of-office hours services.

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Prof Lumsden said: "A major part of the reason behind this guideline is to try to get everyone thinking about it and think, 'I wonder if this woman might be pregnant'. There are very few deaths from ectopic pregnancies but if there are any, there are too many.

"There may be some cost involved in setting up a seven-day specialist service but, in the long-term, it is likely to be cheaper and is certainly better for the woman to have scan facilities and staff with the expertise to assess a woman than it is to treat her in theatre or on a hospital ward after she has collapsed from an ectopic pregnancy or excessive bleeding."

She explained many women were not given enough information about the treatments available to them and said:

"Sometimes I have seen mistakes made because one has tried to deal with things too early and not just waited.

"I think many of the problems arise because our patients do not understand why we are recommending particular treatments, and if people understand why we are saying it would better to wait they will be sure of what we are doing.

"We do not want to treat every pregnancy that would go on to be viable. That would be equally bad."

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Julie Orford, who has had two miscarriages, spoke of her NHS treatment and said: "It felt very much like a conveyor belt. I found it quite insensitive. I was given a cup of tea and leaflet, and just left. We just had bays of women crying.

"We could hear them crying behind their curtains. Nobody really spoke to you in a sensitive manner and there was no information at all."

While she was haemorrhaging, she was placed on a ward next to a labour ward and could hear women giving birth, which made her experience even more distressing.

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Professor Mark Baker, director of the centre for clinical practice at Nice, said: "It is not rocket science to separate those who are having a baby from those who are losing a baby. We just have to think about it and look at the service through the eyes of the patient. This is really about behavioural change. That does not involve additional money, although it might involve education."

The report also seeks to help women who do not access medical help readily, such as recent migrants, refugees and asylum seekers who may have trouble speaking English.

Prof Lumsden said: "These patients are failing to access our services and so will often present very late. If someone can't understand the information you are giving them you have to assume they do not have that."

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