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Recurrent Miscarriage

Checked: 23-03-2023 by Vicky Ryan Next Review: 23-03-2025

Overview

There is information on Recurrent Miscarriage and when to refer in CKS.

These guidelines suggest referral to investigate the cause of recurrent miscarriage for all women who have had:

Three or more first trimester miscarriages.
One or more mid-trimester loss (second trimester)

If a patient who has had recurrent miscarriage becomes pregnant, then consider the following options for advice about the pregnancy:

If already under one of the recurrent miscarriage clinics, then patients should contact them directly for advice.
If not under one of the recurrent miscarriage clinics, then patients should be referred to their local antenatal clinic or discussed with on call gynaecology team.
Reassurance scans are available at NBT for patients who have been seen in the recurrent miscarriage service. Unfortunately, patients who have fallen pregnant whilst awaiting their first appointment are unable to access these scans. If necessary, please discuss referral with the Ultrasound Department at the hospital where they will be booked for their pregnancy:
- St Michaels University Hospital - 0117 342 5347
- Southmead - 0300 555 0103

Scans for reassurance after previous miscarriage or for dating purposes should not be referred to the Early Pregnacy Clinic (EPAC). Patients should only be referred to the Early Pregnany Clinic if they develop symptoms of a possible miscarriage or ectopic.

Before Referral

Investigations

Suggested investigations prior to referral include:

Antiphospholipid profile (including BsFP1, anti-cardiolipin antibodies, lupus anticoagulant screen) - NBT ICE - search for 'Thrombophilia recurrent miscarriage' profile. UHBW ICE - search for 'Antiphospholipid screen'.
FBC
TFT
Thyroid Peroxidase antibody(TPO)
Clotting screen
FSH, LH and estradiol on day 2-5 of cycle.

These tests are not mandatory prior to referral but if done will help to streamline the process for patients.

Please note that thrombophilia screen is not required: As part of NHSE reorganization of Genetics Testing from 1st October 2020 patients with primary infertility/recurrent pregnancy loss or other related obstetric conditions are not eligible for centrally funded Prothrombin Gene Mutation or Factor V Leiden analysis on the grounds of poor clinical utility of these assays in this patient group. These assays will not be processed. Please contact haemseniorbms@nbt.nhs.uk to discuss if concerned.

Advice and Guidance

Gynaecology Advice and Guidance is available via eRS if you are unsure if referral is indicated or need specific advice.

Referral

NBT and UHB both have clinics where patients with recurrent miscarriage can be referred via eRS.

NBT Recurrent Miscarriage Clinic - NBT have a Recurrent Miscarriage webpage for patients.
UHB Reproductive Medicine Clinic

Fertility Referrals

Referral to NHS fertility clinic for patients with recurrent miscarriage is not usually appropriate and referrals will be returned unless criteria are met. See the Infertility page for details.

Resources

(1) Miscarriage | CKS | NICE

Patient Information:

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