Next steps - second trimester miscarriage, ectopic and molar pregnancy

Next steps - second trimester miscarriage

What do we need to do?

In addition to the guidance on first trimester miscarriage

• Ensure that the woman is cared for in the appropriate care environment by staff who are sensitive to her needs.
• Discuss the arrangements, including where she will deliver and possible ways of marking the loss and/or making memories (see section C).
• Prepare the woman and partner for what to expect during labour and delivery, including information about pain relief and how long the process might take.
• Offer to tell the woman and partner what they might expect their baby to look like, depending on the gestation.
• Provide a named contact in case the woman changes her mind or has any questions.
• Ensure all staff seeing the woman and partner during labour and delivery are aware of the baby’s death and communicate sensitively.
• Be conscious that women are likely to need additional emotional support during labour.
• Enable the woman to have a partner or support person with her at all times.
• With the woman’s consent, keep the partner or support person informed.
• Provide the partner or support person with emotional support.

Next steps - ectopic pregnancy

What do we need to do?

In addition to the guidance on first trimester miscarriage

• Give clear and understandable information (verbally and in writing where possible) about management options, risks, benefits and any recommendations, and allow time for discussion and decision making wherever possible.
• Be sensitive to the feelings the woman and partner may have about their loss, risks to the woman and implications for her fertility. Recognise that they may have already been coping with the diagnosis of miscarriage or pregnancy of unknown location.
• If the woman opts for expectant or medical management, explain the need for continued monitoring and further appointments, and advise on the potential need for treatment, further treatment or surgery in some cases. Provide a contact name and/or number so the woman and partner can ask questions or seek advice at any time.
• If surgical management is advised/opted for, clearly and sensitively explain the steps for hospital admission, pre-operative preparation and surgical routes including any recommendations (keyhole, open) and possible outcomes, e.g. for an affected Fallopian tube.
• Provide a contact name so that the woman and partner can ask questions or seek advice.
• Offer to tell the woman and partner what they might expect the remains of their baby or pregnancy to look like, depending on the gestation and the type of management used.
• Provide information about pain relief and physical and emotional care.
• Discuss the options for cremation and burial in the same way as you would following miscarriage - see After the loss.
  
  

Next steps - molar pregnancy

What do we need to do?

In addition to the guidance on first trimester miscarriage

• Give clear and understandable information regarding the recommendation for surgical management if this is needed, recognising that this may be the woman’s second procedure.
• Give clear information about the follow up process, why it is needed and what it will involve.
• Provide contact details of the Scottish Hydatidiform Mole Follow Up Service at Ninewells Hospital, to which the woman will be referred, so the woman and partner can ask questions or seek advice at any time.
• Be sensitive to the feelings the woman and partner may have regarding their loss, the possible risks for the woman’s health and implications for future pregnancies.
• Provide information about organisations that can offer further support.
• Discuss the options for cremation and burial in the same way as you would following miscarriage - see After the loss.

How will we know we have achieved our aim?

Women and partners will tell us they were treated with respect and kindness by staff and received clear information which was sensitive to their individual needs.

Staff will say they feel confident and competent in dealing with women and partners who exhibit any of a range of emotional responses to their situation and in giving clear information.

Go to Marking the loss, making memories