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Table 4 Agreed list of KPIs for recurrent miscarriage care

From: Developing guideline-based key performance indicators for recurrent miscarriage care: lessons from a multi-stage consensus process with a diverse stakeholder group

KPI No.

KPI title

KPI sub-category

KPI category: Structure of care (n = 20)

 1.4(a)

Dedicated recurrent miscarriage clinic on-site

Dedicated clinic

 1.4(b)

Access to dedicated recurrent miscarriage clinic

Dedicated clinic

 1.6(a)

Core recurrent miscarriage team

Staffing/expertise

 1.6(b)

Access to psychological supports

Staffing/expertise

 1.12(b)

Staff education and training

Staffing/expertise

 1.12(a)

Care experience

Staffing/expertise

 1.5

Location of dedicated recurrent miscarriage/pregnancy loss/gynaecology clinic

Location/equipment/facilities

 1.10

Laboratory services

Location/equipment/facilities

 1.3

Formal referral process

Referral structures

 1.2(a)

Referral criteria

Referral structures

 1.2(b)

Specification of referral criteria

Referral structures

 1.18

Education/information for health professionals about referral processes

Referral structures

 1.001

Referral sources

Referral structures

 1.002

Referral times

Referral structures

 1.1

Timing of investigations

Referral structures

 1.14(a)

First visit—written information about what to expect

Information provision and plans

 1.14(b)

Written information about sources of support

Information provision and plans

 1.14(c)

Written information about recurrent miscarriage

Information provision and plans

 1.17(a)

Tailored investigation plan

Information provision and plans

 1.17(b)

Tailored management plan

Information provision and plans

KPI category: Counselling/supportive care (n = 7)

 2.9

Information provision—risk factors: advancing age

Information provision

 2.10

Information provision—modifiable risk factors

Information provision

 2.5

Unexplained recurrent miscarriage—information about prognosis

Information provision

 2.11

Information provision—unorthodox investigations/treatments

Information provision

 2.7

Information provision—treatment uncertainty

Information provision

 2.13

Clinical trials

Information provision

 2.12

Genetic counselling

Genetic counselling

KPI category: Investigations (n = 30)

 3.1

Medical, obstetric and family history

Standard investigations

 3.2

Information about behavioural and weight-related risk factors

Standard investigations

 3.15

Full blood count

Standard investigations

 3.16

Electrolytes and liver function tests

Standard investigations

 3.4

Assessment of uterine anatomy

Anatomical investigations

 3.7

Assessment of uterine anatomy using transvaginal ultrasound

Anatomical investigations

 1.9

Access to 3D ultrasound

Anatomical investigations

 3.12

Imaging/imaging with hysteroscopy to diagnose uterine septa

Anatomical investigations

 3.14

Complete investigation following Müllerian uterine malformation diagnosis

Anatomical investigations

 3.20

Measurement of antinuclear antibodies testing

Immunological screening

 3.21

Natural killer cell testing

Immunological screening

 3.27(a)

Routine screening for hereditary thrombophilia

Haematology

 3.27(b)

Screening for hereditary thrombophilia, with risk factors

Haematology

 3.34(a)

Screening for antiphospholipid syndrome—routine

Haematology

 3.34(b)

Screening for antiphospholipid syndrome—non-routine

Haematology

 3.36

Monitoring of plasma coagulation markers

Haematology

 3.25

Thyroid stimulating hormone, thyroid peroxidase-antibodies, and thyroxine (T4) testing

Metabolic & endocrinologic factors

 3.38

Screening for diabetes

Metabolic & endocrinologic factors

 3.45

Ovarian reserve testing

Metabolic & endocrinologic factors

 3.48

‘Day 2–5’ hormone profile

Metabolic & endocrinologic factors

 3.46

Luteal phase insufficiency testing

Metabolic & endocrinologic factors

 3.47

Androgen testing

Metabolic & endocrinologic factors

 3.55

Vitamin D measurement

Metabolic & endocrinologic factors

 3.51

Infectious screening

Infectious screening

 3.60

Cytogenetic analysis of pregnancy tissue at the third miscarriage

Screening for genetic factors

 3.58

Array-based comparative genomic hybridisation (Array-CGH)

Screening for genetic factors

 3.57

Genetic polymorphism study

Screening for genetic factors

 3.64

Peripheral karyotyping

Screening for genetic factors

 3.65

Cytogenetic testing of both parents

Screening for genetic factors

 3.71

Testing for spermploidy/DNA fragmentation

Screening for male factors

KPI category: Treatment (n = 34)

 4.2a

Treatment of antiphospholipid syndrome—referral to local haematology service

Antiphospholipid syndrome

 4.2b

Treatment of antiphospholipid syndrome—low dose aspirin and heparin in next pregnancy

Antiphospholipid syndrome

 4.4

Treatment of antiphospholipid syndrome—intravenous immunoglobulin therapy

Antiphospholipid syndrome

 4.25

Treatment of subclinical hypothyroidism with levothyroxine

Recurrent miscarriage with metabolic and endocrinologic factors

 4.28

Treatment of overt hypothyroidism with levothyroxine

Recurrent miscarriage with metabolic and endocrinologic factors

 4.30

Treatment of women with subclinical hypothyroidism in next pregnancy

Recurrent miscarriage with metabolic and endocrinologic factors

 4.31

Treatment of women with thyroid autoimmunity and hypothyroidism in next pregnancy

Recurrent miscarriage with metabolic and endocrinologic factors

 4.40

Human chorionic gonadotrophin supplementation in pregnancy

Recurrent miscarriage with metabolic and endocrinologic factors

 4.36

Bromocriptine treatment in women with recurrent miscarriage and hyperprolactinemia

Recurrent miscarriage with metabolic and endocrinologic factors

 4.42

Metformin supplementation

Recurrent miscarriage with metabolic and endocrinologic factors

 4.14

Preimplantation genetic testing

Recurrent miscarriage with genetic background

 4.12

Unexplained recurrent miscarriage: Preimplantation genetic screening with in vitro fertilisation treatment

Recurrent miscarriage with genetic background

 4.8

Oocyte donation

Recurrent miscarriage with poor ovarian reserve

 4.23

Sperm selection

Recurrent miscarriage with male factor

 4.67

Myomectomy (laparoscopic or open)

Uterine factors in recurrent miscarriage

 4.68

Hysteroscopic septum resection

Uterine factors in recurrent miscarriage

 4.71

Metroplasty in women with bicorporeal uterus and double cervix

Uterine factors in recurrent miscarriage

 4.70

Uterine reconstruction for hemi-uterus

Uterine factors in recurrent miscarriage

 1.7

MDT for hysteroscopic metroplasty of a uterine septum

Uterine factors in recurrent miscarriage

 4.74

Surgical removal of intrauterine adhesions

Uterine factors in recurrent miscarriage

 4.43

Use of antibiotics

Antibiotics

 4.61

Unexplained recurrent miscarriage: Supportive care

Unexplained recurrent miscarriage

 4.54

Unexplained recurrent miscarriage: Use of low molecular weight heparin or low dose aspirin

Unexplained recurrent miscarriage

 4.1

Corticosteroids (e.g. prednisolone)

Unexplained recurrent miscarriage

 4.19

Glucocorticoids (clinical studies)

Unexplained recurrent miscarriage

 4.52

Intravenous immunoglobulin

Unexplained recurrent miscarriage

 4.27

Empiric progestogen

Unexplained recurrent miscarriage

 4.57

Unexplained recurrent miscarriage: Intralipid therapy

Unexplained recurrent miscarriage

 4.51

Unexplained recurrent miscarriage: Lymphocyte immunisation therapy

Unexplained recurrent miscarriage

 4.58

Unexplained recurrent miscarriage: Granulocyte colony-stimulating factor

Unexplained recurrent miscarriage

 4.17

Unexplained recurrent miscarriage: Immunotherapy

Unexplained recurrent miscarriage

 4.22

Unexplained recurrent miscarriage: Therapy with tumour necrosis factor-α receptor blockers

Unexplained recurrent miscarriage

 4.59

Unexplained recurrent miscarriage: Endometrial scratching

Unexplained recurrent miscarriage

 4.55

Unexplained recurrent miscarriage: Folic acid

Unexplained recurrent miscarriage

KPI category: Outcomes (n = 19)

 5.1

New pregnancy

New pregnancy

 5.2a

New pregnancy: Spontaneous conception

New pregnancy

 5.2bi

New pregnancy: Ovulation induction and intrauterine insemination

New pregnancy

 5.2bii

New pregnancy: IVF and IntraCytoplasmic Sperm Injection

New pregnancy

 5.2biii

New pregnancy: IVF and IntraCytoplasmic Sperm Injection with donor gametes

New pregnancy

 5.2biv

New pregnancy: Any use of Preimplantation Genetic Testing

New pregnancy

 5.3

New pregnancy reaches 2nd trimester

New pregnancy

 5.4

New pregnancy reaches 3rd trimester

New pregnancy

 5.5

New pregnancy: Avoidance of fetal growth restriction

New pregnancy

 5.6

New pregnancy: Avoidance of placental abruption

New pregnancy

 5.7

New pregnancy: Avoidance of pre-eclampsia

New pregnancy

 5.8

New pregnancy: Avoidance of preterm birth

New pregnancy

 5.9

New pregnancy: Avoidance of stillbirth

New pregnancy

 5.10

New pregnancy: Avoidance of neonatal death

New pregnancy

 5.11

New pregnancy: Treated as high risk, with consultant-led care

New pregnancy

 5.12

Interval to next pregnancy: < 6 months

New pregnancy

 5.13a

Interval to next pregnancy: ≥ 6 months and < 12 months

New pregnancy

 5.13b

Interval to next pregnancy: < 12 months

New pregnancy

 5.16

New pregnancy: Attend early pregnancy clinic/have an early pregnancy scan

New pregnancy