National evaluation for early pregnancy loss support services in early pregnancy units in the United Kingdom

Early pregnancy loss (EPL) includes miscarriage before 14 weeks’ gestation and ectopic pregnancy. Around 20% of pregnancies end in miscarriage and 1 in 80 are ectopic. In the UK, early pregnancy units (EPUs) care for women and their partners diagnosed with an EPL. Although NICE recommends that follow-up should be routinely offered after an EPL, the implementation of this recommendation remains unclear. This study aimed to evaluate the national provision of EPL follow-up care across UK EPUs. A ten-item online questionnaire was disseminated to EPUs across the UK registered with the Association of Early Pregnancy Units. 200 UK EPUs were invited to participate over a six-month period. Completion of the online survey was supported by telephone follow-up to maximise response rates and follow up on missing data. Respondents were asked to provide information on service availability, timing, delivery format, staffing, and barriers to providing follow-up care. Of 200 EPUs, 180 responded (89.5%). 48.9% (88/180) provided EPL follow-up care and 51.1% (92/180) did not. Care was mainly delivered by telephone (67.0%, 59/88), with 14.8% (13/88) face-to-face and 18.2% (16/88) using a combination of both formats. Eligibility criteria for EPL follow-up care also varied across EPUs, with 55.7% of units (49/88) offering appointments to patients who had experienced either a miscarriage or an ectopic pregnancy, 11.4% of units (10/88) offered care to those who had experienced a miscarriage, and 5.7% of EPUs (5/88) to those diagnosed with an ectopic pregnancy. The remaining 27.3% of EPUs (24/88) offered follow-up EPL care to other patient groups, such as those who had experienced recurrent pregnancy loss and those who underwent medical or surgical management of either ectopic pregnancy or miscarriage. Among non-providers, 85.9% supported routine follow-up, citing staffing, funding, and training as key barriers. Overall, 91.1% of EPUs supported further research to develop standardised EPL follow-up pathways. This evaluation demonstrates marked variation and inequity in EPL follow-up care across the UK. Clearer guidance and further research are needed to standardise care and ensure equitable physical and psychological support after EPL.