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New recurrent miscarriages guideline published

Tuesday October 19th 2021

A new draft guideline should help to improve the quality of care provided by women who suffer miscarriage or are at risk, it was announced today.

The guideline, published for consultation by the Royal College of Obstetricians and Gynaecologists (RCOG), brings together the available evidence on possible risks and causes of recurrent miscarriage, potential treatment options, and endorses a ground-breaking model of care for women who have had one or more miscarriages.

Recurrent miscarriage guidelines were last published in 2011 and this new version supports a move towards a graded model of care, which was proposed by experts in The Lancet in April.

In the UK, women can only access support after they have experienced three miscarriages in a row, but this new guideline would enable women to be offered information and guidance to support future pregnancies after one miscarriage.

They would also be able to have an appointment at a miscarriage clinic for initial investigations after two miscarriages, and a full series of evidence-based investigations and care after three miscarriages.

RCOG also redefines the term “recurrent miscarriage” to include non-consecutive miscarriages, which would enable more women to access investigations at an earlier stage.

The guideline also calls for more research to establish why women from Black, Asian or minority ethnic backgrounds are at a higher risk of having a miscarriage.

Lead guideline developer, Professor Dame Lesley Regan, said: “A significant proportion of cases of recurrent miscarriage remain unexplained, despite detailed investigation. These women and their partners can be reassured that the prognosis for a successful future pregnancy with supportive care alone is in the region of 75%.

“Miscarriage can be a devastating loss for women, their partners and families. We, therefore, hope this guideline will provide women and the clinicians caring for them with a consistent and evidence based approach to diagnostic tests, treatment options and supportive care to increase their chances of a successful birth in future.”

For this first time, the guideline highlights increasing paternal age is a risk factor for recurrent miscarriage and it incorporates the results from the PRISM clinical trial published in 2019, which found that giving women with early pregnancy bleeding and a history of miscarriage self-administered twice daily progesterone pessaries can prevent some miscarriages.

It also points out evidence is lacking for interventions such as preimplantation genetic screening (PGS) in conjunction with IVF/ICSI.

Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, said: “Miscarriage is a distressing, shocking and traumatic experience for many women and their partners. For too long, the topic has been under-researched and the care for women and their partners, under-resourced.

“We believe women should access appropriate and standardised care after their first miscarriage and that is why we are endorsing the graded model for miscarriage care in this guideline. This model addresses the balance between the need for evidence based management and supportive care, whilst targeting health care resources effectively.

“We know this is the first step in addressing the gap in care women who experience one or more miscarriages have and urge the NHS to further support this approach and explore ways of implementing this into the care pathway.”

The new guidance was welcomed by the charity Tommy’s.

Chief executive Jane Brewin said: “The right care can reduce the risk of miscarriage, and the right support can help parents if they experience loss – but that help isn’t reaching everyone across the UK after every miscarriage; this can and must change.

“It’s great to see the Royal College taking forward Tommy’s recommendations from our Lancet research in their new care guidelines, so we can prevent more losses wherever possible but also better support those who do sadly lose their babies.”

Tags: Childbirth and Pregnancy | NHS | Nursing & Midwifery | UK News | Women's Health & Gynaecology

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