Recurrent miscarriage is defined as three or more consecutive spontaneous pregnancy losses at less than 20 weeks gestation. Psychological consequences of this can be quite devastating especially for couples who have taken a long time to conceive. It is very likely that there is a close link between recurrent miscarriage and sub-fertility. Some studies have shown that the risk of recurrent miscarriage after two consecutive losses is similar to the risk of miscarriage after three losses. It is therefore reasonable to start the investigation of couples after two or more consecutive spontaneous miscarriages to determine the cause of early pregnancy loss especially where the female partner is over the age of 35 or when a couple have taken longer to conceive than expected or had recurrent implantation failure after assisted conception treatment.
15 to 20% of all clinically recognised pregnancies may end in spontaneous miscarriage and this figure may rise to above 30% when unrecognised pregnancies are taken into account. Two miscarriages without a live birth result in a 35% risk of subsequent spontaneous miscarriage and three miscarriages without a live birth result in a 47% risk of subsequent pregnancy loss.
Assessment of couples will involve taking a thorough history, examination of the female partner and tests to look for uterine abnormalities (ultrasound/3D ultrasound/hysteroscopy) and blood tests to look for clotting disorders, immunological disorders, hormonal disorders, genetic disorders and an infection screen.
A cause for recurrent miscarriage can be determined in around 60% of cases.
A very important part of management involves ongoing emotional and psychological support. Close surveillance using frequent ultrasound monitoring especially in the first 12 weeks of pregnancy has also been shown to improve pregnancy outcome.