Recurrent MiscarriageGreen-top Guideline No. 17.

Area of Science:

• Reproductive Medicine
• Genetics
• Immunology

Background:

• Recurrent miscarriage (RM) affects a significant number of women, impacting reproductive outcomes.
• Current guidelines recommend specific evaluations and interventions for women experiencing recurrent pregnancy loss.

Purpose of the Study:

• To provide evidence-based recommendations for the evaluation and management of recurrent miscarriage.
• To clarify which diagnostic tests and treatments are appropriate for women with recurrent pregnancy loss.

Main Methods:

• Systematic review of existing literature and expert consensus.
• Grading of recommendations based on evidence quality (Grades A-D, GPP).

Main Results:

• Testing for acquired thrombophilia (lupus anticoagulant, anticardiolipin antibodies) is recommended prior to pregnancy.
• Cytogenetic analysis of pregnancy tissue and parental karyotyping are advised in specific circumstances.
• Assessment for congenital uterine anomalies and thyroid dysfunction is recommended.
• Lifestyle modifications including BMI, smoking cessation, and reduced alcohol/caffeine intake are advised.
• Treatment with aspirin and heparin is recommended for antiphospholipid syndrome, but not for unexplained RM.
• Progestogen supplementation may be considered for bleeding in early pregnancy.

Conclusions:

• A targeted approach to recurrent miscarriage evaluation is crucial.
• Specific tests and treatments improve outcomes for certain causes of RM.
• Avoidance of routine, non-evidence-based screening is emphasized.