Understanding Recurrent Pregnancy Loss
Recurrent miscarriage means the loss of two or more pregnancies. It is far more common than most couples realise, and it is exhausting in a way that people around you may not appreciate. The first thing worth saying is that a cause is identified in a large proportion of cases, and that even where no cause is found, the chance of a successful pregnancy afterwards remains good.
The purpose of the evaluation is to look systematically for the causes that can be treated, rather than to repeat the same reassurance after each loss. We work through the investigations in an organised sequence and explain each result as it comes.
What the Evaluation Involves
Both partners are assessed. The investigations are chosen according to your history rather than run as a fixed panel.
- Uterine assessment - ultrasound, and hysteroscopy or 3D imaging where a septum, adhesions, fibroids or polyps are suspected.
- Antiphospholipid antibody testing - one of the most important treatable causes, and straightforward to manage once identified.
- Thrombophilia screening - inherited clotting tendencies, where the history suggests them.
- Hormonal and metabolic tests - thyroid function, prolactin, diabetes screening and PCOS assessment.
- Genetic testing - karyotype for both partners, and testing of pregnancy tissue where available.
- Infection screening - for the specific infections associated with pregnancy loss.
- Treatment plan - low-dose aspirin, heparin, progesterone support, thyroid correction or corrective surgery, depending on what is found.
- Close monitoring in the next pregnancy - early scans, frequent review and easy access to us between appointments.
If you have had two or more losses, please come in for evaluation before trying again. Testing is far more informative when it is done between pregnancies rather than during one.
