Department of Obstetrics and Gynaecology, Pregnancy Loss Research Group, University College Cork, Cork, Ireland.
INFANT Research Centre, University College Cork, Cork, Ireland.
J Obstet Gynaecol. 2023 Dec;43(2):2241916. doi: 10.1080/01443615.2023.2241916.
The appropriate clinical care of women/couples with infertility experiencing recurrent miscarriage (RM) is overlooked in international guidelines. We sought to evaluate care provision for women/couples with RM and infertility across public (19 clinics providing RM care, five fertility clinics) and private sectors (nine fertility clinics) using adapted guideline-based key performance indicators (KPIs) for RM. An online survey comprised of multiple-choice/open questions was administered via Qualtrics from November 2021 to February 2022, encompassing: (i) structure of care, (ii) investigations, (iii) treatments, (iv)counselling/supportive care and (v) outcomes. Clinical leads for pregnancy loss and fertility and clinical nurse/midwife specialists within each unit/clinic were invited to participate.The response rate 73% (24/33), varied by provider: Public RM care (18/19; 95%), 2/5 public fertility (40%); private fertility (3/9; 33%). Access to fertility expertise was limited in public RM clinics (39%). While investigations and treatments provided mostly adhered to guidelines, there was uncertainty regarding immunotherapies. Educational needs identified included fertility counselling, informative and supportive care resources. Clinical outcomes were seldom audited (2/22; 9%). Greater engagement with the private sector is required to unify care across sectors and to ensure standardised evidence-based care. Audit and outcomes reporting should be mandated. Lived experience of current care structures should inform service improvements.Impact Statement There is a paucity of research into the appropriate clinical care of women/couples with infertility experiencing recurrent miscarriage, with a resulting deficit within international RM guidelines. It is known that RM care is variable and often not in line with guidance. This study demonstrates that while care is largely in line with clinical practice guidelines, there is variation in counselling, imaging and surgical treatments offered. Areas for education identified included fertility counselling and resources for information provision and supportive care. Clinical outcomes were seldom audited. Fertility care must expand to ensure access for women with RM and infertility. Further research exploring barriers and facilitators to the delivery of evidence-based care for women/couples with infertility and RM is required. The lived experiences of service users must inform service improvements.
国际指南中忽视了对经历反复性流产（RM）的不孕女性/夫妇的适当临床护理。我们试图使用 RM 的循证指南为 RM 护理（19 家提供 RM 护理的诊所，5 家生育诊所）和私营部门（9 家生育诊所）评估对 RM 和不孕女性/夫妇的护理情况，评估使用了经过调整的基于指南的关键绩效指标（KPI）。从 2021 年 11 月至 2022 年 2 月，通过 Qualtrics 进行了一项包含多项选择题/开放式问题的在线调查，涵盖：（i）护理结构，（ii）检查，（iii）治疗，（iv）咨询/支持性护理和（v）结果。每个单位/诊所的妊娠丢失和生育临床负责人以及临床护士/助产士专家都被邀请参加。应答率为 73%（24/33），因提供者而异：公共 RM 护理（18/19；95%），2/5 个公共生育（40%）；私立生育（3/9；33%）。公共 RM 诊所获得生育专业知识的机会有限（39%）。虽然提供的检查和治疗大多符合指南，但免疫疗法存在不确定性。确定的教育需求包括生育咨询、信息和支持性护理资源。很少对临床结果进行审核（2/22；9%）。需要加强与私营部门的合作，以实现各部门之间的护理统一，并确保标准化的循证护理。应强制进行审核和结果报告。当前护理结构的实际经验应该为服务改进提供信息。影响陈述目前对经历反复性流产的不孕女性/夫妇的适当临床护理的研究很少，这导致国际 RM 指南中存在缺陷。众所周知，RM 护理的情况各不相同，而且往往不符合指南。这项研究表明，尽管护理基本符合临床实践指南，但在提供咨询、影像学和手术治疗方面存在差异。确定的教育领域包括生育咨询和信息提供以及支持性护理资源。很少对临床结果进行审核。生育护理必须扩大，以确保 RM 和不孕女性获得护理。需要进一步研究探索为经历 RM 和不孕的女性/夫妇提供循证护理的障碍和促进因素。服务使用者的实际经验必须为服务改进提供信息。
