Women in most parts of the United Kingdom must experience three consecutive miscarriages before the NHS will investigate the underlying cause. Only then are patients offered blood tests or ultrasound scans to determine why pregnancies are failing. In Scotland, a more responsive approach to early pregnancy loss already exists, but south of the border that standard has not been adopted. A new clinical trial now suggests the case for change is backed by substantial evidence, and that delay has a measurable human cost.

The trial, led by researchers at Tommy's National Centre for Miscarriage Research and Birmingham Women's Hospital, tested what it calls a graded model of miscarriage care. Rather than requiring women to suffer repeated losses before receiving any clinical attention, the approach intervenes at each stage. After a first miscarriage, women would be offered a consultation with a specialist nurse to discuss their health before and during any future pregnancy. Those who experience early vaginal bleeding could be offered progesterone, a hormone used to support early pregnancy. After a second loss, blood tests for anaemia and abnormal thyroid function would be carried out. Women who go on to experience a third miscarriage would receive the current standard NHS care.

The trial included 406 women, split evenly between those given early intervention and those who received usual care. Among the graded group, 86 per cent were found to have at least one factor that could increase their risk of future miscarriage. That figure suggests the existing policy is leaving a significant proportion of women without information or treatment that could affect the outcome of subsequent pregnancies. The trial also found a four per cent reduction in miscarriage risk among women in the intervention group during their next pregnancy.

Among the findings with particular clinical significance: one in five women who had lost two pregnancies were found, through blood tests, to have either thyroid problems or anaemia. Under current NHS guidance, those tests would not have been offered at that stage. Professor Arri Coomarasamy, director of Tommy's National Centre for Miscarriage Research, said that if the graded model were implemented across the UK, the study indicates it could prevent around 10,075 miscarriages every year.

The financial case for reform is set out alongside the clinical one. The report suggests the graded model could save the NHS more than £40 million after a year, when factoring in the cost of supporting pregnancies that would otherwise end in loss and the wider healthcare burden associated with recurrent miscarriage.

Kath Abrahams, chief executive of Tommy's, the baby loss charity, described the current system as inconsistent and said it generally involves no follow-up or tests until after a third loss. She said the three-miscarriage threshold means women and families are left without early access to services that could help prevent future losses. She also pointed to the psychological impact, citing feelings of isolation and hopelessness that the charity says affect many of those who experience pregnancy loss.

The inconsistency Abrahams refers to is not merely anecdotal. The provision of miscarriage care varies by region across England, with some areas offering more support than others depending on local clinical commissioning decisions. Scotland has moved further toward earlier intervention, and proponents of the graded model argue that the rest of the UK has been slow to follow. Whether this research is sufficient to prompt a formal policy review by NHS England remains to be seen. The evidence now exists. The question is whether the health service will act on it.