This is an updated guideline from RCOG on the management of recurrent miscarriage (and some other selected cases). It was last updated in Jun 2011. This update was from Jun 2023.
What is new for GPs in this guideline?
The following factors were new to me, or things that I had forgotten about:
- Miscarriages do not need to be in consecutive pregnancies to count as recurrent.
- Maternal age is the biggest factor for recurrent miscarriage.
- Lifestyle factors like smoking, excess caffeine intake, alcohol (over 10u per week) and a BMI < 19 or > 25 are all linked with an increased risk of recurrent miscarriage.
- Subclinical hypothyroidism and TPO antibodies are a risk factor and patients need to be monitored and may need treatment (see below for more detail).
- Women with antiphospholipid syndrome need aspirin and heparin from the time of their first pregnancy test until 34/40. We will either need to start this, or facilitate it being started.
How do RCOG define ‘recurrent miscarriage’?
In this guideline they define recurrent miscarriage as:
- Three or more first trimester miscarriages OR
- Two or more second trimester miscarriages.
