Current management and research priorities for second trimester pregnancy loss: a survey of healthcare professionals in the UK and Ireland (PASTeL-3)

BACKGROUND: Second trimester pregnancy loss (STPL) is under-researched. There are no published national or international guidelines. Yet evidence suggests this may be a high risk group. We hypothesised that the management of STPL varied across the UK and Ireland and we asked healthcare professionals' views on current care and future priorities for STPL.

METHODS: A prospective cross-sectional survey was conducted as part of the PASTeL-3 project. An electronic online survey was live between 19th November 2024 and 7th March 2025. Professionals working in maternity services in the UK and Ireland were invited to participate the survey via social media and email.

FINDINGS: The definition of STPL varied between hospitals, with lack of consensus on the lower and upper gestational age limits. Care location for assessment and management of STPL differed between hospitals. 43 % of women could self-refer for assessment in the second trimester. Dosages of misoprostol used for STPL varied between hospitals from 50-400 µg, and 63 % of respondents reported uncertainty over the optimal dosage of misoprostol for STPL. Elective surgical management for STPL was rarely offered. Pharmacological management of the third stage of labour after STPL was largely based on oxytocics, with a minority using Misoprostol alone (10 %). Although almost all units reported consultant follow-up, only 45 % of respondents reported routine follow up took place in a dedicated pregnancy loss clinic. Only 52 % of respondents reported that post-mortem examination was routinely offered after STPL. Respondents reported antenatal care after a STPL was provided in a specialist pregnancy loss clinic (31 %) or preterm birth clinic (43 %); 80.1 % reported they felt confident caring for women in a asubsequent pregnancy after STPL. Respondents highlighted concerns with care locations for women with STPL under 16-18 weeks' gestation and contingency locations where bereavement suites were in use. Highlighted research priorities included: optimising medical management of STPL for women with a scarred uterus, medical methods to reduce the risk of retained placenta after STPL, the impact of STPL on next pregnancies and investigations after STPL.

INTERPRETATION: There is confusion over the definitions, appropriate location for care, optimal therapeutic options and follow up needed following STPL. High quality research for STPL should be prioritised to develop evidence-based clinical guidance to reduce variation in care.