Recurrent Miscarriage

Question 1

Define recurrent miscarriage

Answer 1

3 or more consecutive, spontaneous miscarriages
In 1st Trimester
W/ same partner

Question 2

What is the epidemiology of recurrent miscarriage?

Answer 2

1 : 100

Question 3

What is the aetiology of recurrent miscarriage?

Answer 3

• Idiopathic (35%)
• Genetic abnormality
• Fibroids
• Anatomical abnormalities
• Antiphospholipid syndrome, thrombophilic disorders
• Endocrine: uncontrolled diabetes, thyroid
• Infection: BV, chlamydia, gonorrhoea

Question 4

How are recurrent miscarriages investigated?

Answer 4

Parental karyotyping
Cytogenetic analysis of conception products
=genetic abnormalities

Pelvic USS
=fibroids, anatomical abnormalities

Vaginal swabs
=infection

Bloods
=clotting disorder, endocrine

Question 5

How are recurrent miscarriages managed?

Answer 5

GENERAL

• Referral to EPAU
• Genetic referral

MEDICAL

• Antiphospholipid = aspirin and heparin as soon as viable fetus is confirmed
• BV = regular swabs and rotating antibiotics (clindamycin and amoxicillin)

SURGICAL
-Remove fibroids