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 |