HNY Policy and Pathway Repository - York

Miscarriage is defined as loss of a pregnancy before viability – usually 24 weeks.

Requires confirmation of pregnancy with either urinary pregnancy test or USS; not simply delayed menses

The recurrent miscarriage clinic will review couples with >3 first trimester miscarriages or one second trimester miscarriage

None provided

• A baseline USS (outside pregnancy) to exclude uterine pathology
• Day 1-5 FSH, LH (PCOS increases risk of miscarriage)
• Product of conception should be sent to Histology (usually instigated by secondary care) – please offer histology pot if patient has had home miscarriages
• Pre-conceptual advice – smoking cessation advice and folic acid

Information to include in referral letter

• Details of full obstetric history (include miscarriages/TOPs/ectopics)
• Whether any previous treatment to cervix (if so please include date of last smear & result)
• Relevant past medical / surgical history
• Current regular medication

NB – secondary care will organise chromosomal analysis for the couple and thrombophilia screen for the woman

Patient Information

RCOG Recurrent miscarriage patient information leaflet: https://www.rcog.org.uk/en/patients/patient-leaflets/recurrent-andlate-miscarriage/ 
 

References:

1. The investigation and treatment of couples with recurrent first trimester and second trimester miscarriages. RCOG Greentop guideline No 17. April 2011