Initial care during miscarriage in the emergency department: a discussion of international context
Women who experience a miscarriage have unique needs for initial supportive care. This is particularly the case when first attending healthcare facilities, prior to referral to further care pathways, especially in the emergency department. This article explores initial care for women who experience a miscarriage, and argues that while this period might be viewed as transitional, initial supportive care is crucial as it is likely that women will experience heightened emotional turbulence. Although, at times, the transition period may be brief, it is still fundamental to provide women who may be vulnerable with optimal support. The review and discussion in this article particularly reference the context in Brunei Darussalam, but also explore the context of existing international literature.
Miscarriage is a distressing event for both women and their partners. The grief associated with miscarriage may not only relate to the loss of their baby but also to the loss of future plans, hopes and dreams (Meaney et al, 2017). The expected outcome is of a live, healthy baby, and is much anticipated by a pregnant women and her partner. However, pregnancies that result in unintentional loss can have a devastating impact on women, their partners and extended families.
Although the universal definition of miscarriage centres around pregnancy loss before viability (Quenby et al, 2021), the specific cut-off gestation time varies across countries.The World Health Organization (2022) defines miscarriage as the spontaneous or deliberate termination of a pregnancy before the 28th week of gestation or when fetal weight is below 500g. In the USA (Lacci-Reilly et al, 2023), New Zealand and Australia (Royal Australian and New Zealand College of Obstetricians and Gynaecologists, 2021), it is defined as unintended pregnancy loss up to 20 weeks of pregnancy. In the UK, the cut-off extends to 24 weeks (Lee et al, 2023). In Brunei Darussalam, based on the authors’ professional clinical experiences, the cut-off varies across hospitals, typically ranging from 20–24 weeks.
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