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Linehan, L; Hennessy, M; O'Donoghue, K
European Journal of Obstetrics & Gynecology and Reproductive Biology
An examination of care received by women with recurrent miscarriage and infertility against guideline-based key performance indicators
In Press
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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 2008-2020 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.
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