Recurrent Pregnancy Loss (Recurrent Miscarriage)
Recurrent pregnancy loss is defined as two or more losses before 20 weeks. It affects 1–2% of couples and has identifiable, treatable causes in many cases. With the right investigation and care, most couples go on to have a successful pregnancy.

Overview

RPL is defined as two or more losses before 20 weeks. It affects ~1–2% of couples. ESHRE 2023 guidelines recommend investigation after two consecutive losses. Repeated loss suggests a cause worth investigating — and treating.


Causes & Risk Factors

  • Chromosomal abnormalities in the embryo — most common (50–60%)
  • Uterine abnormalities — septate uterus, fibroids, polyps, adhesions
  • Antiphospholipid Syndrome (APS) — autoimmune clotting disorder; key treatable cause
  • Thrombophilias — inherited clotting disorders
  • Hormonal disorders — thyroid, diabetes, hyperprolactinaemia
  • Parental chromosomal rearrangements
  • Advanced maternal age
  • Unexplained in up to 50% — prognosis with supportive care remains good

Diagnosis

  • 3D uterine ultrasound or SIS / hysteroscopy
  • Antiphospholipid antibody testing (confirmed on two tests, 12 weeks apart)
  • Parental karyotyping
  • Thyroid function and antibodies
  • Fasting glucose and HbA1c
  • Products of conception chromosomal testing

Treatment

  • APS — low-dose aspirin + LMWH from positive pregnancy test
  • Uterine surgery — hysteroscopic septum resection, polypectomy
  • Thyroid optimisation — TSH below 2.5 mIU/L
  • Vaginal progesterone — reduces miscarriage risk in unexplained RPL (PRISM 2019)
  • PGT-A with IVF — for parental chromosomal abnormalities or advanced age
  • Psychological support — counselling and peer groups

Experiencing repeated pregnancy loss? Book a consultation today

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