Recurrent miscarriage

Recurrent abortion is the term applied to the situation where a woman has three or more consecutive spontaneous abortions. It affects 1% of all women (1).

Most important predictive factor are the number of previous miscarriages and maternal age (2). Primigravidae and women with a history of successful pregnancies miscarry infrequently.

A successful subsequent pregnancy occurs in around 75% of women with recurrent miscarriages, although this rate may decrease in older women and with the increasing number of miscarriages (3).

• been estimated that, in over half of miscarriages, a chromosomal abnormality is present (4)
  • other risk factors include maternal age greater than 35 years, multiple pregnancies, uterine malformations, polycystic ovaries, autoimmune factors (such as phospholipid antibodies, lupus anticoagulant and cardiolipin antibodies), genetic disorders, poorly controlled diabetes, and having had two or more miscarriages
  • many of these conditions can lead to recurrent miscarriage, traditionally defined as three or more miscarriages
  • for many women and their partners, a cause of recurrent miscarriage may never be found
  • with the development of ultrasound and improvements in pregnancy testing, pregnancies can be diagnosed earlier, even if destined for early miscarriage. In the past, these may not have been detected - therefore, the number of women reporting early pregnancy loss may increase

Reference:

• (1) Royal College of Obstetricians and Gynaecologists (RCOG) 2003. The investigation and treatment of couples with recurrent miscarriage
• (2) Jauniaux E et al. Evidence-based guidelines for the investigation and medical treatment of recurrent miscarriage. Human Reproduction 2006;21(9):2216–2222
• (3) Duckitt K, Qureshi A. Recurrent Miscarriage. Am Fam Physician. 2008;78(8)
• (4) Haas DM et al. Progestogen for preventing miscarriage in women with recurrent miscarriage of unclear etiology Cochrane Systematic Review November 2019.