title: Are national recommendations regarding examination and disposal of products of miscarriage being followed? A need for revised guidelines?
abstract: BACKGROUND
  National guidance documents advise that tissue obtained from treatment of miscarriage should be submitted for histological examination to exclude trophoblastic disease and ectopic pregnancy, and require sensitive disposal of human tissue. The aim of this study was to determine the extent to which health professionals have adopted these recommendations.
  
  
  RESULTS
  Fifteen Scottish Obstetric and Gynaecology services participated in an audit of early pregnancy loss care. Three audit tools were used. In a case note review, 484 women completed medical or surgical treatment for miscarriage. 71% of records contained evidence of histological examination of tissue. Documentation of discussion of disposal of tissue with the woman was found in 29% of records. In a patient survey, 648 women with threatened or confirmed miscarriage returned questionnaires. Active treatment occurred in 134 cases. Only 55%, 50.9% and 47.4% reported being 'informed', 'consented' and 'involved', respectively, with decisions about tissue disposal. In a staff survey, a postal questionnaire was administered to 224 gynaecologists, with 144 replies. Self reported practice as 'seldom' or 'occasional' for sending tissue for histological examination was 34% for surgical evacuation and 57% for medical management. Reporting of 'seldom' or 'occasional' discussion of disposal of tissue with the woman was 42% and 49% for surgical and medical treatment, respectively.
  
  
  CONCLUSIONS
  National guidance on these issues was found to be contentious and implementation was variable. Wide consultation with stakeholders is needed prior to the publication of revised guidance.
authors.affiliation: Department of Obstetrics & Gynaecology, Sunderland Royal Hospital, Kayll Road, Sunderland, SR4 7PT, UK. m.j.cameron@abdn.ac.uk
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Cameron
authors.forename: Gillian C
authors.initials: GC
authors.lastname: Penney
mesh_terms: D000022:Abortion, Spontaneous; D003625:Data Collection; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006291:Health Policy; D006801:Humans; D007258:Informed Consent; D008485:Medical Audit; D017744:Medical Waste Disposal / Q000592:standards*; D009775:Obstetrics and Gynecology Department, Hospital / Q000592:standards; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012606:Scotland; D011795:Surveys and Questionnaires
chemical_list: D017744:Medical Waste Disposal