Recurrent miscarriage: evidence to accelerate action
File(s)THELANCET-D-20-14709 v4.1-clean.docx (210.28 KB)
Accepted version
Author(s)
Type
Journal Article
Abstract
Women who have had repeated miscarriages often have uncertainties about the cause, the likelihood of recurrence, the investigations they need, and the treatments that might help. Health-care policy makers and providers have uncertainties about the optimal ways to organise and provide care. For this Series paper, we have developed recommendations for practice from literature reviews, appraisal of guidelines, and a UK-wide consensus conference that was held in December, 2019. Caregivers should individualise care according to the clinical needs and preferences of women and their partners. We define a minimum set of investigations and treatments to be offered to couples who have had recurrent miscarriages, and urge health-care policy makers and providers to make them universally available. The essential investigations include measurements of lupus anticoagulant, anticardiolipin antibodies, thyroid function, and a transvaginal pelvic ultrasound scan. The key treatments to consider are first trimester progesterone administration, levothyroxine in women with subclinical hypothyroidism, and the combination of aspirin and heparin in women with antiphospholipid antibodies. Appropriate screening and care for mental health issues and future obstetric risks, particularly preterm birth, fetal growth restriction, and stillbirth, will need to be incorporated into the care pathway for couples with a history of recurrent miscarriage. We suggest health-care services structure care using a graded model in which women are offered online health-care advice and support, care in a nurse or midwifery-led clinic, and care in a medical consultant-led clinic, according to clinical needs.
Date Issued
2021-05-01
Date Acceptance
2021-04-01
Citation
The Lancet, 2021, 397 (10285), pp.1675-1682
ISSN
0140-6736
Publisher
Elsevier
Start Page
1675
End Page
1682
Journal / Book Title
The Lancet
Volume
397
Issue
10285
Copyright Statement
© 2021 Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000645510600028&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Grant Number
RDD03 79560
RDD03 79560
Subjects
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
IN-VITRO FERTILIZATION
POLYCYSTIC-OVARY-SYNDROME
ANTIBODY-POSITIVE WOMEN
PREGNANT-WOMEN
LEVOTHYROXINE TREATMENT
SUBCLINICAL HYPOTHYROIDISM
CHROMOSOME ANALYSIS
RANDOMIZED-TRIAL
THYROID-DISEASE
THROMBOPHILIA
Publication Status
Published
Date Publish Online
2021-04-27