Recurrent Miscarriage: Which Tests and What Treatment?

A single miscarriage is heartbreaking but sadly common, and detailed tests are not usually needed after one loss. However, after two or three miscarriages in a row, or after even one loss in the middle part of pregnancy (the second trimester), it is sensible to see a gynaecologist to look for a cause. If the mother is older or has an existing medical condition, advice may be sought earlier.

Tests are chosen based on each person’s history. Those commonly considered include:

• Antiphospholipid antibody tests: these look for a condition that makes the blood more likely to clot and can reduce blood flow to the placenta. Two tests a few weeks apart are needed to confirm it.
• Pelvic ultrasound: this checks the shape of the womb for problems such as a dividing wall (septum), fibroids or polyps. A 3D scan or hysteroscopy may be used if needed.
• Hormone and metabolic tests: thyroid function and diabetes are checked, because poorly controlled conditions raise the risk.
• Genetic tests: tissue from the pregnancy loss can be tested for chromosome problems. In selected cases, both partners may be offered a chromosome test (karyotype).

Treatment depends entirely on what the tests show:

• If antiphospholipid syndrome is diagnosed, blood-thinning treatment is given in the next pregnancy under specialist supervision.
• A uterine septum, polyp or certain types of fibroid may, in some cases, be corrected by hysteroscopy.
• If mid-pregnancy losses are due to a weak cervix (cervical insufficiency), a stitch in the cervix (cerclage) or regular scans of cervical length may be offered next time.
• Thyroid disease or diabetes is brought under good control before trying to conceive.
• If a chromosome problem is found, genetic counselling is offered and the options are discussed.
• For women with bleeding in pregnancy and a history of miscarriage, a doctor may sometimes recommend hormonal support.

Remember, no medicine should be started on your own; taking treatment without a clear reason may do more harm than good.

For many couples all the tests come back normal. This is called unexplained recurrent miscarriage. Even then, the chance of a successful next pregnancy is generally good. Regular check-ups from early pregnancy, an early scan where appropriate, and emotional support are all very helpful. Keeping to a healthy weight, avoiding smoking and tobacco, and taking folic acid before conception also support overall health.