Gynaecological procedure and miscarriage statistics (FOI)

​​Request

A

Why is there no transvaginal ultrasound in A&E? Why are the staff of A&E not trained to do a transvaginal ultrasound for when the Rayner ward is closed? Are pregnant women not considered a Priority outside of office hours? 

B

I would also like to know the miscarriage statistics for 2021-2024 please.

Response

A

The questions posed seek an explanation of service provision. Freedom of Information is a mechanism to enable access to information held in recorded form by a Scheduled Public Authority, rather than to pose questions requiring comment or opinion. The response provides information and rationale based on available records and reference sources.

Early pregnancy scanning is a competency that is accessed by trained gynaecologists, radiologists, and specialist radiographers (sonographers). It is not a requirement or expected competency of Emergency Department (ED) staff to perform such examinations, which require specialist training and expertise. 

As stipulated in policy:

All ultrasound practitioners who undertake an ultrasound examination independently must hold one of the following certifications in obstetrics and gynaecology ultrasound:

• certificate / diploma (as appropriate) in Medical Ultrasound (CMU / DMU) of the College of Radiographers (CoR) with evidence of appropriate continuous professional development (CPD)
• Post Graduate Certificate or Diploma in Medical Ultrasound (PgCert or PGDip) approved and validated by a higher institute of education and accredited by the Consortium for Sonographic Education (CASE or equivalent), the qualification will be relevant to obstetrics and gynaecology ultrasound practice
• Royal College of Obstetricians and Gynaecologists (RCOG) Royal College of Radiologists (RCR) Diploma in Obstetric Ultrasound, the Advanced Skills Training Module in Foetal Medicine, or an RCOG module in obstetric scanning relevant to the scan being performed

Registered health professionals who hold a Certificate in Focused Ultrasound Course such as Third Trimester or Early Pregnancy may perform ultrasound examinations specific to their qualification.

ED staff should contact the on-call Obstetrics and Gynaecology team to review and determine the appropriate pathway of care. The Gynaecology on-call team operate 24-hours per day and also cover the Maternity Unit. Outside of Rayner Outpatients operating hours, there is a clear pathway for ED and Gynaecology teams to follow.

B

As noted in a Freedom of Information response published to www.gov.je in August 2023, the majority of miscarriages occur outside of hospital, in the community, and will not require care through Health and Community Services (HCS) or be reported to the department at the time of occurrence. Additionally, whilst miscarriages that occur in the community may subsequently be recorded in an individual’s medical record, this information is not available in a central database. Therefore, HCS are unable to provide total figures for miscarriages on the island.

HCS holds data on miscarriages that require admission to hospital for care, including ectopic pregnancies requiring management. These cases are identified by the diagnosis codes assigned to the episode of care in the Electronic Patient Record. Admission figures for 2019 to 2021 are included in the referenced response, available at the following link:

Births, stillbirths, miscarriages and terminations 2019 to 2021 (FOI)​

As this information is available elsewhere, Article 23 of the Freedom of Information (Jersey) Law 2011 has been applied.

Admission figures for 2022 through to 30 September 2024 are detailed in the table below. Where numbers are small, disclosure control has been applied to protect individuals from identification, and numbers fewer than five are shown as ‘<5’. Article 25 of the Freedom of Information (Jersey) Law 2011 has been applied to protect the privacy of individuals.

​Data Source: Hospital Patient Administration System (Report CD005DM)

Data for this response is derived from reporting by discharge date. As such, patients who were admitted prior to 01 January 2022 but discharged after this date will be included. For the same reason, patients admitted prior to 30 September 2024 but discharged after this date will not be included in the numbers. 

Clinical Coding of a patient’s admission is carried out after discharge from hospital. Data is incomplete for the time period in question, and consequently, figures may be subject to change as Clinical Coding of admissions continues and completion levels increase.

Articles applied

Article 23 - Information accessible to applicant by other means

(1) Information is absolutely exempt information if it is reasonably available to the applicant, otherwise than under this Law, whether or not free of charge.

(2) A scheduled public authority that refuses an application for information on this ground must make reasonable efforts to inform the applicant where the applicant may obtain the information.

Article 25 - Personal information

(1) Information is absolutely exempt information if it constitutes personal data of which the applicant is the data subject as defined in the Data Protection (Jersey) Law 2005.

(2) Information is absolutely exempt information if –

(a) it constitutes personal data of which the applicant is not the data subject as defined in the Data Protection (Jersey) Law 2005; and

(b) its supply to a member of the public would contravene any of the data protection principles, as defined in that Law.​