Abstract：
OBJECTIVE: 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.
METHODS: We conducted an audit of women with RM and infertility attending our RM clinic from 2008 to 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.
METHODS: We conducted an audit of women with RM and infertility attending our RM clinic from 2008 to 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.
摘要：
目的：复发性流产（RM）的国际管理指南没有为并发不孕症的妇女/夫妇的护理提供详细的指导。有关RM的调查和治疗的研究经常忽略该队列。这项研究的目的是评估在爱尔兰共和国大型三级单位的RM诊所就诊的不孕症妇女/夫妇的护理情况。
方法：我们对2008年至2020年在RM诊所就诊的RM和不孕症女性进行了审计，针对110项既定的RM护理指南关键绩效指标（KPI），包括五类：护理结构，咨询/支持性护理，调查,治疗和结果。信息是从RM诊所的文档中收集的，医院实验室和电子健康记录。
结果：我们确定了128名患有不孕症和RM的女性。可以改善RM诊所有关可改变的风险因素（71％；91/128）和无法解释的RM（53％；69/128）的信息提供。大多数女性都是根据KPI进行调查的，除了盆腔超声（40％；51/128），细胞遗传学剖析(27%；34/128)和三维超声(2%；2/128)。免疫疗法很少开处方（<1%）；然而，98％（125/128）的妇女接受阿司匹林，48%LMWH(62/128)和16%皮质类固醇(21/128)。手术干预并不常见（5％；6/128））。随后的妊娠率为70％（89/128），36%的人接受人工生殖技术(32/89)。活产率为63％（56/89）；37％的人再次流产（33/89），其中两个是妊娠中期流产。
结论：患有RM和不孕症的女性接受的护理在很大程度上符合RM指南的KPI。然而,我们确定了需要改进的地方，包括信息提供的质量，并获得某些调查。虽然基于指南的KPI允许国际适用和可重复的审计，可以指导服务改进，服务用户的体验和需求没有被捕获，值得进一步定性研究。
方法：我们对2008年至2020年在RM诊所就诊的RM和不孕症女性进行了审计，针对110项既定的RM护理指南关键绩效指标（KPI），包括五类：护理结构，咨询/支持性护理，调查,治疗和结果。信息是从RM诊所的文档中收集的，医院实验室和电子健康记录。
结果：我们确定了128名患有不孕症和RM的女性。可以改善RM诊所有关可改变的风险因素（71％；91/128）和无法解释的RM（53％；69/128）的信息提供。大多数女性都是根据KPI进行调查的，除了盆腔超声（40％；51/128），细胞遗传学剖析(27%；34/128)和三维超声(2%；2/128)。免疫疗法很少开处方（<1%）；然而，98％（125/128）的妇女接受阿司匹林，48%LMWH(62/128)和16%皮质类固醇(21/128)。手术干预并不常见（5％；6/128））。随后的妊娠率为70％（89/128），36%的人接受人工生殖技术(32/89)。活产率为63％（56/89）；37％的人再次流产（33/89），其中两个是妊娠中期流产。
结论：患有RM和不孕症的女性接受的护理在很大程度上符合RM指南的KPI。然而,我们确定了需要改进的地方，包括信息提供的质量，并获得某些调查。虽然基于指南的KPI允许国际适用和可重复的审计，可以指导服务改进，服务用户的体验和需求没有被捕获，值得进一步定性研究。
