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Recurrent miscarriage – Information for GPs

Definition

  • Miscarriage is defined as loss of a pregnancy before viability – usually 24 weeks
  • Requires confirmation of pregnancy with either urinary pregnancy test or USS; not simply delayed menses
  • The recurrent miscarriage clinic will review couples with >3 first trimester miscarriages or one second trimester miscarriage

Management

  • A baseline USS (outside pregnancy) to exclude uterine pathology
  • Day 1-5 FSH, LH (PCOS increases risk of miscarriage)
  • Product of conception should be sent to Histology (usually instigated by secondary care) – please offer histology pot if patient has had home miscarriages
  • Pre-conceptual advice – smoking cessation advice and folic acid

Information to include in referral letter

  • Details of full obstetric history (include miscarriages/TOPs/ectopics)
  • Whether any previous treatment to cervix (if so please include date of last smear & result)
  • Relevant past medical / surgical history
  • Current regular medication

NB – secondary care will organise chromosomal analysis for the couple and thrombophilia screen for the woman

Patient information

RCOG Recurrent miscarriage patient information leaflet: https://www.rcog.org.uk/en/patients/patient-leaflets/recurrent-and-late-miscarriage/

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