RCOG. Recurrent Miscarriage Green-top Guideline No. 17 – Nov 2023
The guideline defines recurrent miscarriage as three or more consecutive miscarriages.
The guideline discusses the risk factors for recurrent miscarriage, including:
Age: The risk of miscarriage increases with age.
Previous miscarriages: Women who have had one or more miscarriages are at increased risk of having another miscarriage.
Uterine abnormalities: Women with uterine abnormalities, such as fibroids or polyps, are at increased risk of miscarriage.
Chromosomal abnormalities: Chromosomal abnormalities in either the sperm or the egg can cause miscarriage.
Medical conditions: Certain medical conditions, such as thyroid disease or diabetes, can increase the risk of miscarriage.
The guideline also discusses the investigations that should be carried out in women with recurrent miscarriage. These include:
Karyotyping: This is a test to check the chromosomes of both partners.
Pelvic ultrasound: This is a test to look for uterine abnormalities.
Thyroid function tests: This is a test to check the thyroid gland is functioning properly.
Blood tests: This is a test to check for other medical conditions that could be increasing the risk of miscarriage.
The guideline also discusses the treatments that are available for recurrent miscarriage. These include:
Aspirin: Low-dose aspirin may reduce the risk of miscarriage in women with a history of unexplained recurrent miscarriage.
Heparin: Heparin is a blood thinner that may reduce the risk of miscarriage in women with antiphospholipid antibody syndrome (APAS).
Progestogen supplementation: Progestogen supplementation may reduce the risk of miscarriage in women with a history of recurrent progesterone deficiency.
Immune therapy: Immune therapy is a treatment that may be used in women with certain types of recurrent miscarriage.
The guideline concludes that recurrent miscarriage can be a distressing experience, but there are treatments available that can help women to achieve a successful pregnancy. Women who have had recurrent miscarriages should be offered specialist care and support.
Key recommendations:
Women with recurrent miscarriage should be advised to maintain a BMI between 19 and 25 kg/m2, smoking cessation, limit alcohol consumption and limit caffeine to less than 200 mg/day.
Progestogen supplementation should be considered in women with recurrent miscarriage who present with bleeding in early pregnancy (for example 400 mg micronised vaginal progesterone twice daily at the time of bleeding until 16 weeks of gestation).
Royal College of Obstetricians and Gynaecologists. Recurrent Miscarriage Green-top Guideline No. 17. BJOG. 2023 Nov;130(12):e9-e39.