An examination of care received by women with recurrent miscarriage and infertility against guideline-based key performance indicators. (March 2023)

• Record Type: Journal Article
• Authors: Linehan, Laura; Hennessy, Marita; O'Donoghue, Keelin
• Is Part Of: European journal of obstetrics, gynecology, and reproductive biology. Volume 282(2023)
• Page Start: 17
• Page End: 23
• Publication Date: 2023-03
• Subjects: Recurrent miscarriage -- Infertility -- Reproductive medicine -- Quality; Obstetrics -- Periodicals; Gynecology -- Periodicals; Reproductive health -- Periodicals; Gynecology -- Periodicals; Obstetrics -- Periodicals; Reproduction -- Periodicals; Obstétrique -- Périodiques; Gynécologie -- Périodiques; Reproduction -- Périodiques; Verloskunde; Gynaecologie; Voortplanting (biologie); Gynecology; Obstetrics; Reproduction; Electronic journals; Periodicals; Electronic journals; 618.05
• DOI: 10.1016/j.ejogrb.2023.01.002
• Languages: English
• ISSNs: 0301-2115

Abstract

Highlights: We used guideline-based KPIs to examine RM care in women who also had infertility. Overall care was in keeping with KPIs, but areas for improvement were found. Counselling regarding individual risk factors and treatments could be improved. Greater access to genetic counselling, ultrasound and cytogenetic investigation is needed. In subsequent pregnancy, the ART rate was 36% while the livebirth rate was 63% Abstract: Objectives: International guidelines for the management of recurrent miscarriage (RM) do not provide detailed guidance for the care of women/couples with concurrent infertility. Research studies concerning the investigation and treatment of RM frequently omit this cohort. The aim of this study was to assess the care of women/couples with infertility attending a RM clinic in a large tertiary unit in the Republic of Ireland. Study design: We conducted an audit of women with RM and infertility attending our RM clinic from 2008 to 2020 against 110 established guideline-based key performance indicators (KPIs) for RM care, encompassing five categories: structure of care, counselling/supportive care, investigation, treatment and outcomes. Information was gathered from documentation from the RM clinic, hospital laboratory and electronic health records. Results: We identified 128 women with infertility and RM. Information provision in RM clinics regarding modifiable risk factors (71 %; 91/128) and unexplained RM (53 %; 69/128) could be improved. Most women were investigated in line with KPIs, except for pelvic ultrasound (40 %; 51/128), cytogenetic analysis (27 %; 34/128) and 3D ultrasound (2 %; 2/128). Immunotherapies were seldom prescribed (<1%); however, 98 % (125/128) of women received aspirin, 48 % LMWH (62/128) and 16 % corticosteroids (21/128). Surgical interventions were uncommon (5 %; 6/128)). The subsequent pregnancy rate was 70 % (89/128), with 36 % undergoing artificial reproductive technology (32/89). The livebirth rate was 63 % (56/89); 37 % had a further pregnancy loss (33/89), of which two were second-trimester miscarriages. Conclusions: Women with RM and infertility received care largely in line with RM guideline-based KPIs. However, we identified areas for improvement, including the quality of information provision, and access to certain investigations. While guideline-based KPIs allow for internationally applicable and reproducible audit that can direct service improvements, the experiences and needs of service-users are not captured, meriting further qualitative research.