# Recurrent miscarriage

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class WD65.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Recurrent Pregnancy Loss - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK554460/
- Verified date: 2026-08

## Verified against

- No dose - referral pathway, no medicine given in primary care
- Recurrent miscarriage - disease-level clinical article (recurrent-miscarriage-full.txt)
- Recurrent miscarriage - disease-level clinical article (recurrent-miscarriage-clinical.txt)

## Treatment metadata

- No drug therapy in primary care (Referral & Advice)

## Complete treatment card

```text
RECURRENT MISCARRIAGE
Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class WD65.00 -
         condition scope only, no dose · No dose - referral pathway, no medicine given in primary
         care · Recurrent Pregnancy Loss - StatPearls - NCBI Bookshelf -
         https://www.ncbi.nlm.nih.gov/books/NBK554460/
Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care,
               Recurrent miscarriage - disease-level clinical article (recurrent-
               miscarriage-full.txt), Recurrent miscarriage - disease-level
               clinical article (recurrent-miscarriage-clinical.txt)  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (2)
    - Losses tend to recur around the same point in pregnancy each time, so the exact gestational
      age of each prior loss should be documented.
    - A prior D&C raises the risk of Asherman syndrome or cervical incompetence, either of which can
      drive further loss.
  TESTS (8)
    - Diabetes, thyroid disease, and elevated prolactin should be excluded with appropriate blood
      work.
    - Karyotyping both partners can uncover a balanced translocation or mosaicism, although the
      yield is low and cost is a factor.
    - Pelvic ultrasound, saline sonohysterography, hysterosalpingogram, hysteroscopy, or MRI can
      identify a contributing uterine anomaly.
    - Testing should look for lupus anticoagulant plus antibodies against cardiolipin and beta-2
      glycoprotein, the antiphospholipid panel.
    - Checking progesterone levels routinely isn't recommended, since it doesn't predict how a
      future pregnancy will go.
    - Endometrial biopsy isn't a useful test here, since studies show it doesn't reflect a woman's
      fertility status.
    - Routine screening for chlamydia, gonorrhea, bacterial vaginosis, or TORCH infections isn't
      helpful in an otherwise well woman with recurrent loss.
    - Genetic testing of tissue from the second and later miscarriages is recommended, and combined
      with standard workup finds a probable cause in over 90 percent of cases.
  IF NOT THIS - what else fits (2)
    - A chromosomal problem in the fetus is the most commonly identified cause, alongside cases
      where no cause is ever found.
    - Less often, antiphospholipid syndrome, cervical incompetence, a parental chromosomal issue, or
      poorly controlled diabetes are behind the losses.
  Source  StatPearls "Recurrent Pregnancy Loss" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)    [1st line]
   Adult    Recurrent, consecutive miscarriages warrant referral for specialist work-up of
            underlying causes such as anatomical, endocrine, autoimmune, or genetic factors. -
            Refer, with advice
   Peds     Adult-only condition - paediatric section not applicable
   Source   No dose - referral pathway, no medicine given in primary care
   Why      Recurrent, consecutive miscarriages warrant referral for specialist work-up of
            underlying causes such as anatomical, endocrine, autoimmune, or genetic factors.
   Caution  RED FLAG - Antiphospholipid syndrome presenting with arterial/venous thrombosis: assess
            urgently and refer.
            Recurrent second-trimester loss may indicate cervical insufficiency needing specific
            obstetric management.
            No medicine is prescribed for this in primary care - this entry is for recognition and
            referral. Anything given is decided by the service it is referred to.
            RED FLAG - Antiphospholipid antibody syndrome (present in 8-42% of RPL cases) increases
            the risk of maternal thrombosis and placental insufficiency.
            RED FLAG - Recurrent pregnancy loss carries a severe psychological impact and is
            associated with depression, anxiety, and low self-esteem.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
```

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