The NHS has been told to improve its care of the tens of thousands of women a year who suffer an early miscarriage or ectopic pregnancy.
A mother-to-be who may be at risk of losing her baby should be able to have a scan on whichever day of the week symptoms such as pain and bleeding occur, including the weekend, according to guidelines drawn up by the National Institute for Health and Clinical Excellence (Nice).
The NHS in England and Wales should consider setting up dedicated services for women who have suffered a miscarriage within the first 13 weeks of their pregnancy or an ectopic pregnancy, Nice adds.
At least 20% of pregnancies end in miscarriage, affecting around 200,000 women a year in England. About 11 women in every 1,000 who become pregnant have an ectopic pregnancy, where a fertilised egg ends up somewhere other than in the uterus, the vast majority (95%) in one of the woman's fallopian tubes.
There were 35,495 confirmed ectopic pregnancies between 2006 and 2008.
Six of the women concerned died during the first trimester of their pregnancy as a direct result of them expecting a child, the institute said. "About two-thirds of deaths caused by ectopic pregnancy are associated with substandard care, due to missed or late diagnosis," Nice said.
Nice is also recommending improved training to help GPs identify the symptoms of either event in order to help detect an ectopic pregnancy earlier, as doing so is important to help the woman avoid any later pregnancy-related complications and reduce the risk of death.
Dr Dan Poulter, the health minister who is also an obstetrician and gynaecologist, said all NHS hospitals and GP practices should implement Nice's advice to avoid further loss of life. "Pregnant women deserve nothing less than the best care possible. This guideline has real potential to save lives. Many hospitals and community care settings already ensure high-quality care for women at risk of ectopic pregnancy or miscarriage, but provision of services can sometimes show unacceptable variations throughout our NHS," said Poulter.
Annette Briley, a research midwife at the baby charity Tommy's, said: "It's very reassuring to see these guidelines about better care for women who suffer an ectopic pregnancy and miscarriage. Ectopic pregnancy can be very dangerous and can impact on the future fertility of a woman."
Because incidence rates of early pregnancy miscarriage are so high, "so are the chances of women falling through the care gap and not getting appropriate treatment and support, which can vary hugely across the country. However, increased support, care and treatment takes resource and investment, so it is good to see these recommendations, and these problems being put higher on the agenda," added Briley.
Prof Mark Baker, director of Nice's centre for clinical practice, said: "It can be very distressing and, in some cases, frightening to experience a miscarriage or be told your pregnancy is ectopic. It's vital that women and their families receive good, consistent, timely and effective care and support that addresses their needs and enables them to make informed decisions.
"We know that not every woman is receiving this level of treatment at the moment but this guideline will address that inconsistency and ensure all women receive excellent care, no matter where they live."
