Hi Stacy - an interesting question.  I work in ChCh, NZ so we do have the major Women's Hospital alongside us (on the same site) but we still see many women in the first instance out of hours or when the woman is uncertain as to what is occurring, if she is pregnant, or where the event is related to trauma rather than as a spontaneous event.  What in particular are you interested in, in relation to this topic, as the question is quite  broad?  Is it specific to the ED nurses response to such situations? their experiences of it? their responses / protocol? are you looking at all types of ED or those where there is no immediate option to refer onto a gynae hospital or setting? are you looking more at medical or trauma related miscarriage? those associated with domestic violence?  If you can provide some further advice, I am happy to offer some thoughts, or feel free to email me directly.  I am attaching some generic articles that may be of interest for background reading from an international perspective: also Bacidore, V et al (2009) A Collaborative Framework for managing pregnancy loss in the emergency department Journal of Obstetric, Gynaecologic and Neonatal Nursing 38, 730-738, DOI:10.1111/j.1552-6909.2009.01075.x

Dr. Richardson's comments are excellent!!  I work on the west coast in the USA we do have plenty of patient who present to the ED with the final diagnosis of miscarriage.  Many of these patients are frightened and unsure of what the sudden onset of vaginal bleeding means.  Many of these patient may call their OB/GYN or PCP but many times are sent to the ED for actual evaluation and treatment.  Some of the patients have had profuse bleeding necessitating an emergent trip to the OR for a D&C as well as a transfusion of O negative un-crossmatched PRBCs.  In my career I have personally cared for three patients who were in hemorrhagic shock.  The importance of determining if an ectopic pregnancy is present also necessitates emergent evaluation in the ED.  Some patient have some vaginal bleeding with a viable and healthy fetus necessitating pelvic rest.  Great question--hope that helps!

Good evening and thank you for assisting me and getting me to probe more into my question! It was very helpful.

I work in Wellington so we have access to gynae services and outpatient services too although have strict criteria for ED to send these patients up to them.

I am interested in spontaneous miscarriage and not traumatic. I am definitely interested in ED nurses perspectives of their response to these situations (rather than what should be done i.e. policy) and questions around the triage system and if they feel they are able to support these women (as I feel due to time constraints and the medical model of emergency nursing may not support this). I guess my aim to examine the thoughts and feelings of nurses in terms of miscarriage and how this can be improved and how patient care can be improved.

I agree that some women have bleeding that may require emergency care and also ectopic pregnancy may also require them to seek ED review however sometimes women are sent to ED for assessment without any of these (e.g. USS confirmation and light bleeding) where an emotional need is greater than the medical need however other services may be more appropriate. However, this doesn't mean they will stop coming to ED so I guess thats why I wish to examine ED nurses perceptions in order to improve their support and also examine nurses preparedness for offering this support. 

I have read all of these articles you have provided, many thanks. I found the ‘fetal loss framework’ interesting and wished we could provide this for all however we have a LONG way to go before we get to that in NZ e.g. more ED beds maybe?