Recurrent miscarriage: evidence to accelerate action

Women who have suffered repeated miscarriages often have uncertainties about the cause, the likelihood of recurrence, the investigations that they need, and the treatments that may help. Health care policy-makers and providers have uncertainties about the optimal ways to organise and deliver care. We have developed recommendations for practice from literature reviews, appraisal of guidelines and a UK-wide consensus conference, held in December 2019.

Caregivers should individualise care according to the clinical needs and women’s and partners’ preferences. We define a minimum set of investigations and treatments to be offered to couples suffering recurrent miscarriages, and urge healthcare policy-makers and providers to make these universally available. The essential investigations include measurements of lupus anticoagulant, anticardiolipin antibodies, thyroid function, and a transvaginal pelvic ultrasound scan. The key treatments to consider are first trimester progesterone administration, levothyroxine in women with subclinical hypothyroidism and the combination of aspirin and heparin in women with antiphospholipid antibodies. Appropriate screening and care for mental health issues and future obstetric risks, particularly preterm birth, fetal growth restriction and stillbirth, will need to be incorporated into the care pathway for couples with a history of recurrent miscarriage. We suggest health services structure care using a ‘graded model’ where women are offered online healthcare advice and support, care in a nurse or midwife-led clinic, and care in a medical consultant-led clinic, according to clinical needs.