Women who have had repeated
miscarriages often have uncertainties about the cause, the likelihood of
recurrence, the investigations they need, and the
treatments that might help.
Health-care
policy makers and providers have uncertainties about the optimal ways to organise and provide care. For this Series
paper, we have developed recommendations for practice from
literature reviews, appraisal of guidelines, and a UK-wide
consensus conference that was held in December, 2019.
Caregivers should individualise care according to the clinical
needs and preferences of
women and their partners. We define a minimum set of investigations and
treatments to be offered to
couples who have had
recurrent miscarriages, and urge
health-care
policy makers and providers to make them universally available. The essential investigations include measurements of
lupus anticoagulant,
anticardiolipin antibodies,
thyroid function, and a transvaginal pelvic ultrasound scan. The key
treatments to consider are
first trimester progesterone administration, levothyroxine in
women with subclinical
hypothyroidism, and the combination of
aspirin and
heparin in
women with
antiphospholipid antibodies. Appropriate
screening and care for
mental health issues and
future obstetric
risks, particularly
preterm birth,
fetal growth restriction, and
stillbirth,
will need to be incorporated into the care pathway for
couples with a
history of
recurrent miscarriage. We suggest
health-care
services structure care using a graded model in which
women are offered online
health-care advice and support, care in a
nurse or
midwifery-led clinic, and care in a medical
consultant-led clinic, according to clinical
needs. (AU)