How to organise patient-centered care in early pregnancy

We address patient-centered care for women and / or couples with complications in early pregnancy. Complications include miscarriage, recurrent miscarriage and ectopic pregnancy. We investigated the actual patients’ and doctors’ perspectives on early pregnancy care.
We did so by first focusing on how early pregnancy care was valued by women and/or their partners by means of a systematic review. This review identified which aspects of care were valued by women and/or their partners faced with miscarriage or recurrent miscarriage, and their perspectives on actual given care. However, this review also revealed that there were no data available on care aspects in women diagnosed with ectopic pregnancy. Therefore, the next topic was to assess how women and their partners experienced the trajectory of diagnosis and treatment.
Thereafter, we looked at the doctors’ perspectives on early pregnancy care. We examined whether the establishment of the EPAU in the AMC Amsterdam in 2008 had improved the quality of early pregnancy care by assessing whether the pre-set goals were reached in the period after the establishment. This proved to be the case, but since this design is open to bias we realised that a better tool to measure quality of care would be to use evidence-based quality indicators. We thus developed a set of indicators to measure care provided by EPAUs more accurately. We used these indicators to compare early pregnancy care provided by hospitals with and without an EPAU. Lastly, we describe the organisation of patient-centered care in a recurrent miscarriage clinic.