GynaePulse
Early pregnancyFree in the app

Recurrent miscarriage

Three or more first-trimester losses (investigate after 2 if a cause is suspected).

Source: RCOG GTG 17 (2023)

Investigate

  • Lupus anticoagulant and anticardiolipin antibodies
  • Thyroid function and TPO antibodies
  • 3D ultrasound for uterine anomaly
  • Pregnancy tissue karyotype (3rd+ loss); parental karyotype if unbalanced or no tissue
  • Thrombophilia (FVL, prothrombin, protein S) only after second-trimester loss

Treat

  • Antiphospholipid syndrome: aspirin + heparin from positive test to ≥34 weeks
  • Bleeding in early pregnancy: vaginal progesterone 400 mg BD to 16 weeks
  • No aspirin/heparin for unexplained loss; no levothyroxine if TPO+ with normal thyroid
  • Lifestyle: BMI 19–25, caffeine <200 mg/day
A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.