treatment

Last edited 08/2020 and last reviewed 08/2020

Management involves exclusion of known aetiological factors and tender loving care (1).

Bed rest and lifestyle changes like smoking cessation, reduction in alcohol intake and loosing weight may be helpful (2).

HCG and progesterone have been used to improve function of the corpus luteum:

  • evidence supporting hCG supplementation to prevent recurrent miscarriage remains equivocal (3)
  • in women with unexplained recurrent miscarriages, supplementation with progestogen therapy may reduce the rate of miscarriage in subsequent pregnancies (4)

The following treatment methods have been used but with unknown effectiveness (2):

  • if raised luteinizing hormone is the problem, GnRH agonists, ovarian diathermy and somatostatin therapy may all be of benefit
  • intravenous immunoglobulin therapy
  • folic acid – for women with hyperhomocysteinaemia (2)

Treatment which are unlikely to be helpful:

  • Immunising women (with paternal leukocytes or trophoblast membranes) against recurrent miscarriage has been attempted, but, only one randomised trial has shown any benefit
  • vitamin supplementation (2)

In patients with antiphospholipid syndrome, low dose aspirin and heparin reduce placental infarction and thrombosis (1).

  • the use of combined unfractionated heparin and aspirin may reduce pregnancy loss by 54% in patients with antiphospholipid antibody or lupus anticoagulant (5)

There is some limited evidence that low dose aspirin and heparin is an effective treatment for preventing recurrent miscarriages in women with Factor V Leiden mutation (6).

Notes:

  • a study revealed that low molecular weight heparin + aspirin did not confer incremental benefit compared to aspirin alone for the study population (7)
    • study population comprised women with a history of recurrent pregnancy loss and at least 1 of the following: antiphospholipid antibody (aPL), an inherited thrombophilia, or antinuclear antibody

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