NMH

NMH | 2024 77 Maternity & Obstetrics Prof Cathy Allen with input from the multidisciplinary Reproductive Genetics team. Dr David Crosby further supports this clinic and counselled 56 couples following early pregnancy loss in the reproductive genetics clinic. Since the introduction of new HSE guidelines in January 2024, there has been a significant increase of 55% in the number of cases seen in the Miscarriage Clinic. In 2024, we managed 135 new cases of Recurring Pregnancy Loss in 1st trimester, and Pregnancy Loss in 2nd trimester, compared to 87 in 2023 and 87 in 2022. This does not capture all of the additional referrals which are triaged and returned to referring clinicians with recommendations on management. The Recurrent Pregnancy Loss service at NMH continues to be unique in Ireland in having expert Genetics input into the cases. A fortnightly multidisciplinary team meeting occurs between the teams from Genetics, Recurring Miscarriage and Bereavement: all case referrals are reviewed and individualised plans are agreed. This approach has led to targeted, faster interventions and reduction in unnecessary tests, thus benefitting patients and reducing costs for the Hospital. All the clinics provide an opportunity to determine how parents are coping with grief and loss and risk assess those who may need additional support. Medical information, obtained through investigations including haematological, microbiological, sonographic, radiological, genetic and histology is shared. The MRI scanner at the Hospital assists in this specialised area and images are reviewed by the Consultant Radiologist. Clinics are supported by Consultant Pathologists Dr Paul Downey and Dr Eoghan Mooney, who provide valuable information through rapid histological placental examination and post-mortem examination. Dr Sam Doyle, Consultant Clinical and Biochemical Geneticist provides expertise and counsels couples in cases where genetic assessment is required. Internment The Bereavement Midwives arrange all hospital burials or cremation of miscarriages. Burials or cremations were organised for 39 babies following early or mid-trimester miscarriage in 2024. We believe time invested in preparing babies for burial with respect and dignity is one of the most important aspects of our work. Annual Service of Remembrance The Annual Remembrance Service was held on the 2nd Sunday in October, coinciding with Pregnancy Loss Awareness week. It is an important day in the hospital calendar where bereaved parents, their families and hospital staff come together to remember all babies that have died during pregnancy and around the time of birth. Dedicated 1-1 Bereavement Support Service Support, information and advocacy continues to be provided to women who have experienced the death of a baby at any stage of pregnancy. The introduction of a dedicated 1-1 bereavement support service in 2024 is bridging the gap in holistic bereavement care in the NMH. Since the service commenced in mid-April, 39 women availed of the service which is available one day per week, online or in person. 51% attended in-person and 48% online. 20% of attendees availed of all 6 sessions, with the remainder having their grief and loss validated and normalised based on their individual needs. 46% of attendees experienced recurrent miscarriage, 38% experienced a miscarriage/ectopic pregnancy, 8% experienced mid- trimester loss and 8% stillbirth. Feedback from patients has been very positive with women stating it has been hugely beneficial in navigating the challenges faced moving forward. Pregnancy After Loss Support Group This continued during the year in collaboration with the Perinatal Mental Health Team. 24 women attended the online support groups in February, May, September and November, with plans to evaluate the service next year. We continue educational input with staff and student midwives within the hospital, UCD and the Centre for Midwifery Education. The Hospice Friendly Hospitals standard of care initiatives are in place. Multidisciplinary bereavement education sessions continued in 2024 and Brenda was invited to develop and facilitate a National Grief in Maternity Settings Workshop in March 2024. Brenda Casey, CMS Bereavement and Prof Cathy Allen, Consultant Obstetrician & Gynaecologist.

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