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RCM welcomes NICE guidelines on ectopic pregnancies

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

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.”

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.

Commenting on NICE guidelines, Jane Munro, Quality & Audit Professional Advisor at the Royal College of Midwives, said: “The RCM welcomes these guidelines, they will help to ensure standardised and consistent care for women.

“Women experiencing pain and bleeding in early pregnancy need to be able to access help and support seven days a week. The focus on emotional support and information giving is important, so that women can be clear about their choices and make informed decisions.

“The guidelines will also help to raise awareness of the signs and symptoms of a potential ectopic pregnancy amongst all healthcare professionals involved in the care of women of reproductive age. We look forward to their widespread implementation.”

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.”

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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