A fifth (20%) of UK mothers feel they were not offered adequate antenatal care during their pregnancy, according to an alarming new survey commissioned by The London Clinic.
More than half (57%) of the 2,000 women questioned admitted they would like to have been offered more scans during their pregnancy. The need for general reassurance was the most common reason (76%) for this, while 18% felt they should have received more attention because they had previously suffered complications.
Perhaps unsurprisingly, miscarriage was the most common concern among mums-to-be in the first three months of their pregnancy (93%). One in four pregnancies end in miscarriage – an estimated 250,000 in the UK each year.
A new Early Pregnancy Screening Service, that we have recently launched, will provide reassurance and treatment for women in the first five to twelve weeks of their pregnancy.
Concerns such as vaginal bleeding, discharge, pelvic/abdominal pain, or a history of pregnancy problems can be treated via a unique consultant-led, highly streamlined process, to include:
- Screening and scans, to include 3D/4D imaging and tests for chromosomal abnormality
- Counselling
- Follow-up investigations and care The new service also provides telephone advice from GPs and referring clinicians five days per week, Monday to Friday.
Detailed insight
As starkly highlighted in the survey, there is a real demand for more general reassurance among mums-to-be from medical professionals. By being able to provide a more detailed insight into the health of unborn babies, we hope our new service will greatly help to allay any worries mums-to-be may have.
Likewise, it is more common in the first 12 weeks of pregnancy to suffer a miscarriage or ectopic pregnancy.
Studies show that early pregnancy scans help identify potential problems and thereby reduce overall anxiety which, in turn, leads to more support and confidence during early pregnancy. There are treatable causes of recurrent miscarriage that can be prevented by early pregnancy assessment.
Bleeding in early pregnancy is the most common complication of pregnancy and one of the most common medical complications in general. It makes parents-to-be extremely anxious and all women presenting with bleeding in pregnancy should have access to an ultrasound examination and professional expertise. Women who are unfortunate to present with an ongoing miscarriage in early pregnancy should also benefit from immediate support from experts in the field of reproduction and be provided with rapid access to medical or surgical treatment, if required.
The early human embryo develops in a relatively protected environment where the traffic of substances from mother to feotus, including oxygen, is tightly controlled. Factors that interfere with early development may well result in spontaneous miscarriage or adverse outcome later in pregnancy.
Complications
First trimester miscarriage is the most common complication of pregnancy and affects 10-20% of women with clinically recognised pregnancies. Miscarriage can be broadly categorised into two main groups, sporadic, affecting 20-25% of the population and recurrent (defined as 3 or more consecutive miscarriages before 20 weeks gestation) affecting approximately 1% of couples trying to conceive. The causes for recurrent miscarriage have been traditionally divided into six main categories: anatomical, endocrine, genetic, Infectious, immune and idiopathic. However, it is apparent that in many cases the cause is multifactorial, and the emergence of inherited thrombophillic defects as a frequent cause of recurrent miscarriage has dramatically changed the investigation and management of these women.
Increasing knowledge about early pregnancy development, with the more widespread availability of serum Beta HCG measurement, the advent of high resolution ultrasound and a clearer description of gestational age at pregnancy loss make for a more sophisticated assessment of miscarriage history but also for the couple awareness of a pregnancy from as early as 5 weeks of gestation. The advent of high- resolution ultrasound imaging has enabled the anatomy and physiology of the human pregnancy to be studied in utero from as early as the 3rd week post- implantation onwards. In particular, transvaginal ultrasound with its ability to provide in vivo accurate images of the early gestational sac has also provided pivotal clues on the epidemiology and pathophysiology of early pregnancy failure. Ultrasound plays a major role in maternal reassurance, where fetal cardiac activity is seen and is pivotal in the assessment of early pregnancy complications, such as vaginal bleeding.
Women presenting with vaginal bleeding in the first trimester are commonly investigated using ultrasonography to assess the viability of the pregnancy and to exclude alternative diagnoses such as ectopic pregnancy. The emergence of Early Pregnancy Units (EPU) in many hospitals has addressed the need for a dedicated clinical area fo the diagnosis of miscarriage and patient support at a distressing time. The most recent Confidential Enquiry into Maternal Deaths conclusively demonstrates that mortality from ectopic pregnancy has not declined and is still on the increase on rates described 10 years ago (CEMACH Report, 2004). As the EPU represents the most likely point of ectopic pregnancy diagnosis, the importance of standardized reporting of very early pregnancy changes requires a robust approach following recent recommendations.
