New Australian guidelines for miscarriage and early pregnancy loss released

Australia's first comprehensive national guidelines for the treatment of early pregnancy loss have been welcomed by women's health experts.

The clinical guidelines, developed by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), are designed to provide a benchmark for best practice medical care.

"We don't actually have a standard of care for miscarriage in Australia because every health service does something slightly different and every clinician probably does something slightly different," Nisha Khot, obstetrician and president-elect of RANZCOG, said.

Early pregnancy loss is common in Australia; it's estimated up to one in four pregnancies end in miscarriage, and more than 100,000 couples are affected by miscarriage every year.

The clinical guidelines, published in late April, provide recommendations for the treatment of miscarriage, recurrent miscarriage and ectopic pregnancy up to 14 weeks gestation.

Ectopic pregnancy occurs when a fertilised egg implants and grows outside the uterus.

Dr Khot said in addition to providing health professionals with up-to-date evidence on the medical and surgical management of pregnancy loss, the guidelines were about ensuring empathy was "central to all the care we provide".

Among the recommendations is a new definition of recurrent miscarriage, which was previously defined as a woman having three consecutive miscarriages.

"[The new guidelines] have very specifically said that it is two miscarriages and they don't need to be consecutive for women to be able to access further testing to find out the cause," Dr Khot said.

Isy Oderberg, co-founder of the Early Pregnancy Loss Coalition, said the guidelines would go a long way to supporting women and families who experience early pregnancy loss.

"The time to just tell patients to go home and try again is over," Ms Oderberg said.

"We need to offer patients proper care, proper oversight, let them know they're not alone, and not compound any grief they are already feeling with substandard care or a lack of empathy."

Tackling stigma and silence around miscarriage

Ms Oderberg, who had seven miscarriages on her way to having two living children, said miscarriage care varied significantly across the country and often came down to luck.

"There are times when you go and seek care and you have an incredible, empathetic, knowledgeable clinician who can give you the right guidance and treat you well, both from a medical point of view but also in terms of empathy," she said.

"It varies wildly and it gets worse when the person is from a marginalised or minority group, or if they're in a regional or rural area."

Culturally, there has long been a discomfort around early pregnancy loss, she said, which has contributed to poor understanding of patients' needs and how to best support them.

"We've seen a lot of doctors be dismissive … because it's just seen as a natural part of the reproductive cycle, which to some extent it is, but that doesn't lessen the grief."

A global review of evidence in 2021 found the impact and consequences of miscarriage were "underestimated". It called for a comprehensive overhaul of the medical care and advice offered to women who have miscarriages.

The new Australian guidelines recommend that communication with patients is "clear, empathetic and respectful" and that health professionals take care with terminology and use of certain phrases when discussing early pregnancy loss.

"If the patient refers to their loss as a baby, [doctors] have to take that lead and refer to it in the same way," Ms Oderberg said.

"It compounds a patient's grief if they don't take that lead, and use words like 'spontaneous abortion', which is still commonly used by a lot of doctors."

Investing in research and data

In 2024, the federal government committed $9.5 million to miscarriage support and research, including funding a scoping study for a national miscarriage data collection.

Ms Oderberg said it was important to understand where early pregnancy loss occurred, who was most affected, and whether rates were increasing.

"The reason we need miscarriage data is because you can't create any sort of health policy without knowing who you're creating it for, where they are, how many people need the service … it's a fundamental plank of any decent policy."

The Early Pregnancy Loss Coalition is now hoping to develop a national miscarriage road map, similar to the National Stillbirth Action and Implementation Plan, in order to look long-term at patient pathways, quality of care, and research funding.

"A lot of what happens in this space of early pregnancy loss is not well understood because it is not well researched," Dr Khot said.

"That is because there hasn't been funding for research in this area."

In addition to further research, she said more psychological support was needed for women and families experiencing early pregnancy loss.

"Whether that be counselling or mental health support, these are things women should have access to without additional costs."

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