Recurrent miscarriage
Definitions (2 losses in Australasia and ESHRE, 3 in RCOG), the workup that changes management (APS, thyroid, uterine imaging, genetics), aspirin plus LMWH for obstetric APS, and the treatments that failed in trials (LMWH in unexplained loss, levothyroxine in TPO-positive euthyroid women, which ACCEPT still allows as a low-evidence option).
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Definition: two or more pregnancy losses before 20 weeks (ACCEPT 2024, the first Australasian guideline) or two or more losses (ESHRE 2022). RCOG 2023 keeps three or more first-trimester miscarriages.
- About 1 to 2% of couples are affected. 50 to 75% have no cause found.
- The physician's role is the antiphospholipid, thyroid, diabetes and medicine questions. The gynaecologist manages uterine and genetic causes.
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Sources
- Australasian recurrent pregnancy loss clinical management guideline 2024, Part IAU/NZSuker A et al. (ACCEPT group). Aust N Z J Obstet Gynaecol 2024, 2024 (current; condensed position paper 2025)
- Australasian recurrent pregnancy loss clinical management guideline 2024, Part IIAU/NZSuker A et al. (ACCEPT group). Aust N Z J Obstet Gynaecol 2024, 2024
- ACCEPT group condensed position paper on the management of recurrent pregnancy lossAU/NZSuker A et al. Aust N Z J Obstet Gynaecol 2025, 2025
- ESHRE guideline: recurrent pregnancy loss: an update in 2022ESHRE Guideline Group on RPL. Hum Reprod Open 2023;2023(1):hoad002, 2022 update (published 2023; current, November 2026)
- Recurrent miscarriage: Green-top Guideline No. 17Regan L et al. Royal College of Obstetricians and Gynaecologists. BJOG 2023;130:e9-e39, 2023
- Guideline No. 464: Recurrent pregnancy lossSociety of Obstetricians and Gynaecologists of Canada. J Obstet Gynaecol Can 2025, 2025
- The 2023 ACR/EULAR antiphospholipid syndrome classification criteriaBarbhaiya M et al. Arthritis Rheumatol 2023;75:1687-702, 2023
- Heparin for women with recurrent miscarriage and inherited thrombophilia (ALIFE2)Quenby S et al. Lancet 2023;402:54-61, 2023
- A randomized trial of progesterone in women with bleeding in early pregnancy (PRISM)Coomarasamy A et al. N Engl J Med 2019;380:1815-24, 2019
- Micronized vaginal progesterone to prevent miscarriage: a critical evaluation of randomized evidence (PRISM subgroup with 3 or more losses: live birth 72% vs 57%, RR 1.28)Coomarasamy A et al. Am J Obstet Gynecol 2020;223(2):167-176, 2020
- A randomized trial of progesterone in women with recurrent miscarriages (PROMISE)Coomarasamy A et al. N Engl J Med 2015;373:2141-8, 2015
- Septum resection versus expectant management in women with a septate uterus: an international multicentre open-label randomized controlled trial (TRUST)Rikken JFW et al. Hum Reprod 2021;36:1260-7, 2021
- Levothyroxine in women with thyroid peroxidase antibodies before conception (TABLET)Dhillon-Smith RK et al. N Engl J Med 2019;380:1316-25, 2019
- Aspirin or heparin or both for improving pregnancy outcomes in women with persistent antiphospholipid antibodies and recurrent pregnancy lossHamulyák EN et al. Cochrane Database Syst Rev 2020;(5):CD012852, 2020
- Chance of live birth: a nationwide, registry-based cohort studyKolte AM et al. Hum Reprod 2021;36:1065-73, 2021
- Doxycycline in women with recurrent miscarriage and chronic endometritis, double-blind multicentre randomised placebo-controlled trialHum Reprod 2026, 2026
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy