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Keywords:

  • human chorionic gonadotrophin;
  • pathophysiology;
  • progesterone;
  • recurrent miscarriage

Key content

  • One to three per cent of couples are affected by recurrent miscarriage (defined as more than three consecutive pregnancy losses).
  • Current interventions are centred on known causes of aetiology.
  • Recent research on miscarriage of unknown cause has investigated the requirements for successful embryo implantation.
  • Treatment of immunological risk factors with immunotherapy does not have a strong evidence base.
  • The overall evidence supporting the use of human chorionic gonadotrophin supplementation during pregnancy is inconclusive.
  • The efficacy of progesterone as an intervention remains empirical, with further trials under way.

Learning objectives

  • To understand the aetiology of recurrent miscarriage and patient risk factors.
  • To understand the theoretical pathophysiology underlying miscarriage of unknown aetiology.
  • To be aware of the potential agents of intervention for recurrent miscarriage and their efficacy.

Ethical issues

  • Treating patients with recurrent miscarriage can be emotive; should women be treated with interventions that have limited evidence-based clinical efficacy?
  • How do we manage patients with the psychological impact of recurrent miscarriage?