Recurrent Miscarriage, RCOG Guideline (June, 2023)

Recurrent miscarriage has been defined as three or more first trimester miscarriages. However, clinicians are encouraged to use their clinical knowledge to recommend extensive evaluation after two first trimester miscarriages, if there is a suspicion that the miscarriages are of pathological and not of sporadic nature. Women with recurrent miscarriage should be offered testing for acquired thrombophilia, particularly for lupus anticoagulant and anticardiolipin antibodies, prior to pregnancy. Women with second trimester miscarriage may be offered testing for Factor V Leiden, prothrombin gene mutation and protein S deficiency, ideally within a research context. Inherited thrombophilia’s have a weak association with recurrent miscarriage.
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[@hadiyaa_s14]

❤you are amazing me qualified gyneacologist mcpc love to listen you from a long time.Jazakallah khair

[@AAUN]

Thanks alot dear

[@hinasarwar7804]

Thanks❤😊

[@sabakhalid8885]

Very crisp clear and to the point ☝️ thanks ❤🎉

[@ZT2023]

Thanks mam

[@drsyeda2974]

Hello Dr,
I am a medical graduate from India residing in Canada, 27/F suffering with RPL. Periods and ovulation is regular. I have a short cycle of 5/25 days (loosing eggs faster). 1st pregnancy was blighted ovum that got miscarried at 11 weeks, 2nd was missed miscarriage at 10 weeks. Blood work and sonohysterorography has come normal. Husband’s blood screening and seminal counts and DNA fragmentation is within normal limits. No comorbidities or relevant family history on both the sides. My endometrial biopsy showed 6 plasma cells and vaginal swab was positive for ureaplasmas. I completed 1 week of amoxicillin treatment and husband had 2 weeks of doxycycline treatment. Repeat endometrial biopsy is suggestive of chronic endometritis. Genetic karyotyping reports are awaited. Thyroid and ovarian hormones within normal limits. AMH is 12.06 pmol/l (i.e 1.68 ng/ml) Didn’t conceive in the last 2 monitored cycles. Currently 3rd month of follicular study is going on without ovulation induction. I’ve been suggested to go for IVF. Kindly give your expert opinion. Thank you

[@Dr.khushb00]

Thank you for recent updates

[@AAUN]

wellcome dear

[@dr.asmagul5525]

Please on hrt lecture much needed

[@FaizaElsunni]

Vaginal progesterone was for preterm labour prevention with the toccolytics and corticosteroids. Good when nowadays we can use it in. First trimester .can we add aspirin and heparin to it if unexplained recurrent miscariage?????miscariage

[@FaizaElsunni]

Do you think nowadays we can use vaginal progesterone in the first trimester ?? It was systemic progesterone inj or tabs for luteal phase support.

[@farhanwadood6177]

Definition not clear, recurrent miscarriage refers to 3 consecutive miscarriages or even nonconsecutive miscarriages also included?

[@AAUN]

Infact the RCOG guideline which is explained in this video state that
Owing to the fact that the incidence of certain
diagnoses does not appear to differ between women with consecutive versus non-consecutive
losses, the definition in the present guideline has not been restricted to women suffering with consecutive miscarriages only.
However
The definition of Recurrent Miscarriages is different in different places.
ACOG defines its as two or more miscarriages.
www.acog.org/womens-health/faqs/repeated-miscarriages
The national library of Medicine defines it as 3 consecutive pregnancy losses prior to 20 weeks.
www.ncbi.nlm.nih.gov/pmc/articles/PMC2709325/

[@farhanwadood6177]

So can we give enoxaparin empirically in such patients whether consecutive or nonconsecutive 1st trimester miscarriages

[@AAUN]

As far as the role of enoxaprain is concerned , the guideline says don't give Aspirin or low molecular weight heparin in patients with unexplained miscarriages . It is only helpful if we strongly suspect APS and the diagnostic criteria of APS is
1)-three or more consecutive miscarriages before 10 weeks of gestation;
2)-one or more morphologically normal fetal losses after the tenth week of gestation;
3)-one or more preterm births before 34+0 weeks of gestation because of placental disease.
So in APS diagnostic criteria the word Consecutive is written even in this new guideline.

[@user-ev9ot5tw3o]

Very helpful fast forwarded revision... Allah bless u dear... It's very helpful for specialists away from postgraduate teaching institute....

[@AAUN]

@@user-ev9ot5tw3o
Thanks alot for appreciation dear.