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The loss of a baby at any stage of pregnancy can have a devastating impact on a woman, her partner, and their family. If this loss occurs several times, the experience can often be intensified and prolonged. In this blog, Marita Hennessy, Rebecca Dennehy & Rachel Rice from the Pregnancy Loss Research Group at Cork University Maternity Hospital (CUMH)/University College Cork,  discuss how the RE:CURRENT (Recurrent miscarriage: Evaluating current services) study is evaluating recurrent miscarriage services in Ireland, to inform efforts to standardise and optimise these services. 

There are various definitions of recurrent miscarriage within and between countries. Depending on the definition and population under study, recurrent miscarriage affects 1-6% of women of reproductive age. In this project, recurrent miscarriage is defined as two or more consecutive first trimester miscarriages – in line with the European Society of Human Reproduction and Embryology (ESHRE) guidelines.

The RE:CURRENT study, recently funded by the Health Research Board (HRB), is evaluating recurrent miscarriage services in Ireland to inform efforts to standardise and optimise these services. The Management Group comprises Dr Keelin O’Donoghue (PI), Dr Sarah Meaney (Co-Applicant) and two postdoctoral researchers – Dr Rebecca Dennehy, and Marita Hennessy, PhD. They are supported by a Steering Group, and a Research Advisory Group comprising key stakeholders including healthcare and allied health professionals, representatives from advocacy and support organisations, those involved in the administration, governance and management of maternity services, academics, and women and men who have experienced recurrent miscarriage.

The risk of miscarriage depends on a number of factors, including maternal age and number of previous miscarriages. While there are several causes of recurrent miscarriage, no cause is identified in half of cases following investigations and are ‘unexplained’. Many couples are unprepared for a miscarriage, and are often dependent on healthcare professionals to guide them around management and investigations. Individualised care, appropriate clinical information, and respect for the experiences, views, and wishes of those who experience recurrent miscarriage is important. However, there is currently no national standard for the provision of services and supports.

Clinical practice guidelines for recurrent miscarriage have been published by some professional organisations, and while there are guidelines on miscarriage in Ireland, there are none specific to recurrent miscarriage care. The team is currently conducting a systematic review of guidelines for the investigation, management, and follow-up of recurrent miscarriage – the protocol for which was recently published in HRB Open Research. The aim of the systematic review is to identify, appraise and describe published clinical practice guidelines for the management, investigation and/or follow-up of recurrent miscarriage within high-income countries. This will be a valuable first step in informing efforts to promote the optimisation and standardisation of the recurrent miscarriage care.

Findings from the systematic review will be combined with insights from a qualitative study of stakeholder views on recurrent miscarriage services (recruitment for this study is underway) to systematically generate, and agree, key performance indicators for care. These indicators will then be used in an audit of recurrent miscarriage services within the 19 maternity units/hospitals in the Republic of Ireland. The research team will also examine the investigation, management and outcomes of women who have received care for recurrent miscarriage within the South-South West Hospital Group. In 2021, we will conduct a national survey to examine women’s and men’s experiences of recurrent miscarriage care. A health economic analysis will examine the evidence on costs, outcomes and stakeholder preferences to determine the value of recurrent miscarriage clinics.

The various elements of this project serve to increase our understanding of the investigation, management, and follow-up of recurrent miscarriage. We hope that these efforts will support the optimisation and standardisation of recurrent miscarriage care in the Republic of Ireland, as well as contributing to the international evidence base.

For more information about pregnancy loss and/or miscarriage, please visit the following: http://www.corkmiscarriage.com and http://pregnancyandinfantloss.ie/ and the study website.

For more information about the HRB’s open research publishing platform, HRB Open Research, please visit: https://hrbopenresearch.org/