Human Reproduction, Vol 13, 478-482, Copyright © 1998 by Oxford University Press
TC Li
Recurrent miscarriage is a heterogeneous condition which has many possible
underlying causes. Ideally, couples with the problem should be managed in a
dedicated miscarriage clinic, with thorough investigations according to a
protocol, with structured history and investigation sheets. Counselling is
an important feature and may be provided by a specially trained counsellor,
or specialized nurse appropriately trained in counselling. Counselling
should include an explanation of the possible underlying causes of the
condition, and of the prognosis of each of the conditions. There is no
definite cause of miscarriage in approximately half of the patients. No
treatment is needed in this group, apart from reassurance and tender loving
care. Treatment of unproven value, for example progesterone support in
early pregnancy, should not be offered. Treatment offered empirically or as
part of a research project should have a sound scientific and statistical
basis, and should include careful counselling with informed consent of the
patient. There are many controversial issues in the management of recurrent
miscarriage; consequently, there is a need for locally agreed guidelines
for management. Women who conceive again should be offered regular
monitoring, including serial ultrasonography in the first trimester of
pregnancy. An active audit programme to review regularly the various
outcome measures set against defined targets should be established in the
clinic.
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Recurrent miscarriage: principles of management
Jessop Hospital for Women, Sheffield, UK.
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