New Draft Guidance Addresses Recurrent Miscarriage

Pavankumar Kamat

October 21, 2021

The Royal College of Obstetricians and Gynaecologists (RCOG) has issued a new draft guideline on recurrent miscarriage. The guideline addresses key areas, including risks factors and aetiology of recurrent miscarriage, potential treatment strategies, management of subsequent pregnancies and best supportive care practices.

The new draft guideline supports a graded model of care, recommended by experts in a review published in  The Lancet  in April 2021.

Currently, women in the UK can only receive support after having experienced three consecutive miscarriages. The new graded approach provides information and guidance to women following one miscarriage, a consult at a miscarriage clinic following two miscarriages and comprehensive evidence-based investigations and care following three miscarriages.

The term 'recurrent miscarriage' has also been revisited to include non-consecutive miscarriages, enabling more women to seek support at an earlier stage.

Furthermore, the guideline draws attention to health disparities in the Black, Asian or minority ethnic (BAME) population who have a greater risk of miscarriage, and advocates additional research in this area.

For the first time, increasing paternal age has been recognized as a risk factor for recurrent miscarriage, however, not as significantly as maternal age. The guideline incorporates findings from the 2019 PRISM trial which supports the use of self-administered progesterone pessaries for possible prevention of miscarriages in some women with early pregnancy bleeding and a history of miscarriage.

The guideline also underscores the lack of evidence for certain interventions such as preimplantation genetic screening supplementary to in vitro fertilisation/intracytoplasmic sperm injection.

Professor Dame Lesley Regan, who led the guideline development, said: "Miscarriage can be a devastating loss for women, their partners and families. We, therefore, hope this guideline will provide women and the clinicians caring for them with a consistent and evidence-based approach to diagnostic tests, treatment options and supportive care to increase their chances of a successful birth in future."

Dr Edward Morris, President of the RCOG, added: "We believe women should access appropriate and standardised care after their first miscarriage and that is why we are endorsing the graded model for miscarriage care in this guideline. This model addresses the balance between the need for evidence-based management and supportive care, whilst targeting health care resources effectively."

This article originally appeared on Univadis, part of the Medscape Professional Network.

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