The Royal College of Obstetricians and Gynaecologists (RCOG) has today released two resources aimed to improve the care and support available to women who experience recurrent miscarriage.
The RCOG has updated the Green-top Guideline for healthcare professionals, bringing together evidence-based approaches into a clinical guideline specifically for investigating and treating recurrent miscarriage. This is defined as three or more first trimester miscarriages.
The Green-top Guideline is published alongside a new Patient Information resource, which answers frequently asked questions about recurrent miscarriage. This resource aims to help women better understand what support is available, the recommended investigations and treatments, and aid informed discussions with their healthcare professionals.
The clinical guideline sets out best practice to ensure that all women and people who experience recurrent miscarriages can access evidence-based treatment options, and appropriate supportive care. The guideline redefines recurrent miscarriage to now include non-consecutive pregnancy losses, and losses with different partners.
While there is currently insufficient evidence to support progesterone use for asymptomatic women with unexplained recurrent miscarriage, the guideline outlines that progesterone supplementation should be considered in women with recurrent miscarriage who experience bleeding in early pregnancy.
The guideline is specifically for the care of women that have experienced three or more miscarriages. However, the RCOG supports a move towards the graded approach outlined in The Lancet series, and encourages clinicians to use clinical discretion to recommend evaluation before three miscarriages, if they believe there may be a pathological cause.
The graded approach will improve care and bridge the current gap between sporadic and recurrent miscarriage care provision in the UK. However, there must be investment in services to ensure the NHS capacity and clinical workforce is available to deliver this additional care to women.
Dr Ranee Thakar, President of the Royal College of Obstetricians and Gynaecologists, said:
“Sadly a significant proportion of recurrent miscarriages remain unexplained, despite detailed investigations. However, we hope that these resources will provide women and the clinicians caring for them with a consistent and evidence-based approach to tests, treatment options and supportive care to increase the chance of a successful future pregnancy.
“While outside the scope of this guideline, we know that there is a need to improve the care of women and people after their first or second miscarriage, through a graded model of care. We continue to urge the NHS to support this graded care approach, and explore ways of implementing this into the care pathway.”
Notes to editors
- Read the Green-top Guideline: Recurrent miscarriage
- Read the Patient information: Recurrent miscarriage
- The Lancet Series on Miscarriage is a collection of three papers examining global evidence on the epidemiological, physical, psychological, and economic costs of these early pregnancy losses, as well as making recommendations for best practice care and support based on this review. This outlines a graded model of care, where women are provided with individualised care earlier, rather than after three miscarriages.
Women and their families affected by miscarriage can access support through the following charities: Tommy’s and Miscarriage Association.