Strategies for Addressing Recurrent Pregnancy Loss (Virtual Symposium)-HANDOUT: 03-Stone

HANDOUT: 03-Stone_RainbowClinic

Pdf Summary

The document presents an overview of the Rainbow Clinic approach to caring for women who have experienced stillbirth—a fetal death at or after 20 weeks of gestation or weighing at least 350 grams. Stillbirth remains a significant global health issue, with higher rates in low-income countries (22.7/1000 births) compared to high-income countries (3/1000). In the U.S., the incidence is approximately 6/1000 births, with half occurring before 28 weeks and half after.<br /><br />Risk factors for stillbirth include non-Hispanic Black race, first pregnancies, advanced maternal age, obesity, existing medical conditions, and lifestyle factors, although many occur without apparent risk. Importantly, a history of stillbirth greatly increases the risk of recurrence and other complications such as preeclampsia, low birthweight, and preterm birth. Subsequent pregnancies can be psychologically challenging.<br /><br />The Rainbow Clinic model, developed initially in the UK and adapted at Mount Sinai, offers specialized, multidisciplinary care tailored to women with prior pregnancy loss. Core components include enhanced surveillance (frequent antenatal visits, fetal monitoring, ultrasound), individualized medical management (e.g., low-dose aspirin, thrombophilia testing), and psychological support with dedicated coordinators and peer support options. Sensitive communication acknowledging previous loss and continuity of care are prioritized.<br /><br />Studies on Rainbow Clinic services have shown reductions in recurrent stillbirth and preterm birth rates, improved gestational age at delivery, and lower composite adverse outcomes. Patient satisfaction is high, with women reporting feeling supported, understood, and less anxious. The ongoing Tommy’s National Rainbow Clinic Study aims to further validate benefits, including cost-effectiveness.<br /><br />At Mount Sinai, the Rainbow Clinic began in 2022, providing preconception and pregnancy care for over 110 women, reinforcing individualized management based on clinical and psychosocial needs. Feedback emphasizes the value of consistent staff, private and supportive environments, and integrated postpartum follow-up.<br /><br />In summary, Rainbow Clinics exemplify an evidence-based, compassionate model that combines medical surveillance and psychological care to improve outcomes and experiences for women after stillbirth, with ongoing research to refine and expand these services.

Keywords

Rainbow Clinic

stillbirth

pregnancy loss

multidisciplinary care

antenatal surveillance

psychological support

risk factors

recurrent stillbirth

maternal health

Mount Sinai