P-393 The care experiences of women and men who have received recurrent miscarriage care in Ireland: a national survey
Authors: Flannery C , Dennehy R , Hennessy M , Matvienko-Sikar K , Lucey C , O'Donoghue K 
Published: June 2022

Abstract

Study question
What are the care experiences of women and men who have received recurrent miscarriage (RM) care in the Republic of Ireland?

Summary answer
Of the participants, 24% rated a poor experience of RM care (n = 32), while 36% said the care they received was much worse than expected (n = 48).

What is known already
International guidelines suggest that couples who experience RM should be referred for specialist investigations, support and, if possible, treatment. Providing individualised care, respect for women’s opinions, and appropriate clinical information is imperative to those experiencing RM. However, currently, there is no national standard for the management, investigation, or follow-up of those who experience RM in Ireland. Research on patient-centred early pregnancy care concluded that it is essential for healthcare professionals (HCPs) to realise that women undergoing miscarriage experience a significant life event and recommended that future studies explore potential targets for improving RM care and patients’ perspectives.

Study design, size, duration
A cross-sectional study of women and men who have experienced RM was conducted. An anonymous web-based national survey was used to examine the experience of those who have interacted with the maternity services following RM. The survey was distributed online using Qualtrics between September – November 2021. The survey was shared through emails, websites, newsletters, and social media accounts as well as the Pregnancy Loss Research Group and the Miscarriage Association of Ireland among others.

Participants/materials, setting, methods
Women and men over 18 who have experienced two≥ first trimester miscarriages in the last ten years and who have received care for RM in the Republic of Ireland were invited to participate in the survey. The survey was purposefully designed using relevant literature, including questions on key areas such as sociodemographic information, pregnancy and pregnancy loss history, investigation and treatment for RM. Descriptive statistics and subgroup analysis are ongoing using Stata.

Main results and the role of chance
In total, 213 participants completed the survey (some did not experience a consecutive RM or receive care between 2011-2021 (n = 65)). Therefore, 147 participants were eligible (97% female, n = 135). Of the female participants, 79% were aged 35-44 years (n = 106), 95% were white Irish (n = 128) and 84% were married (n = 114). Women were educated, with 38% having postgraduate degrees (n = 53) or a university degree (27%, n = 36). 57% had experienced two consecutive RM (n = 77) and 25% three consecutive RM (n = 34). Of the 135 women, 53% had investigations for RM (n = 71), with 45% having investigations after two RM (n = 32) or 27% after three RM (26). When asked if their HCP did everything to investigate their RM, 49% said no. Of those who had investigations (n = 71), 83% always had confidence and trust in their HCP (n = 59), and 42% felt treated with dignity and respect (n = 30). However, 44% did not have a HCP to talk to about their worries and fears (n = 31). 24% of women rated a poor experience when receiving RM care (n = 32), 36% said the care they received was much worse than expected (n = 48), with 60% of women saying that HCPs in different places did not work well together during their RM care (n = 81).

Limitations, reasons for caution
Despite an open call to recruit women and men, only four men participated. Therefore, further research needs to include strategies to recruit men to provide a complete picture of RM care experiences. There is also the potential for recall bias as some women received care several years ago.

Wider implications of the findings
This study demonstrates that the overall experience for RM care is poor, providing areas for improvements such as communication and better care coordination between HCPs across hospitals/units. These results provide a better understanding of the drivers shaping care experiences to help inform and improve RM care in Ireland.

Trial registration number
not applicable