Recurrent miscarriage

Question 1

What is recurrent miscarriage in the UK?

Answer 1

loss of 3 or more pregnancy with or without previous live birth

Question 2

What are risk factors for recurrent miscarriages?

Answer 2

Age (maternal and paternal)
Number of previous pregnancy losses
Black ethnic background
Smoking
BMI >25 or <19
Excess alcohol consumption
Excess caffein consumption
Thrombophilia - antiphospholipid syndrome

Question 3

What are genetic factors of recurrent miscarriages?

Answer 3

Fetal chromosome anomalies
Parental chromosomal rearrangements

Question 4

What are anatomical factors of recurrent miscarriage?

Answer 4

Congenital uterine anomalies e.g. septate uterus
Acquired uterine anomalies e.g. fibroids, endometrial polyps, intrauterine adhesions

Question 5

What are endocrine factors of recurrent miscarriage?

Answer 5

PCOS
Prolactin imbalances - maintaining normal level of prolactin beneficial
Luteal phase defect (less evidence)
Well controlled diabetes and thyroid disease - no effect

Question 6

What are recommended investigations for recurrent miscarriages?

Answer 6

Investigations only done if suspected (counselling more important)

Thrombophilia testing
- Only in acquired thrombophilia
- Not inherited thrombophilia testing
Genetic testing:
- Cytogenetic analysis pregnancy tissue after 3rd miscarriage
- Parental peripheral blood karyotyping
Pelvic USS
TFTs and TPO antibodies

Question 7

What are treatment options for recurrent miscarriage?

Answer 7

Lifestyle modifications
Psychological support
Antiphospholipid syndrome - aspirin and LMWH
Genetics team for couple with chromosomal arrangements
Consider removal of uterine septum
Endocrine team if uncontrolled thyroid disease