All Services

Recurrent Pregnancy Loss Service

Pippa Tinker - Recurrent Miscarriage Specialist 

Recurrent Loss Service Information

• What is Recurrent Miscarriage?

  A miscarriage is the loss of a pregnancy under 24 weeks gestation. When this happens 3 times or more, it is called recurrent miscarriage. For individuals and their partners, this is understandably very distressing.

  Recurrent miscarriage affects 1 in 100 (1%) of women and birthing people. This is about three times more than we would expect by chance, so it seems that for some individuals there may be a specific reason for their losses. In some cases, a treatable cause can be identified. However, in around half of patients, no underlying problem is identified after thorough investigations. This is known as unexplained recurrent miscarriage. It’s important to know that many couples who experience unexplained miscarriages go on to have a successful pregnancy with the right support and care.

• Who can be referred?

  We accept referral to Recurrent Miscarriage Clinic for patients who meet the following criteria:

  • 3, or more losses and age < 35 years old
  • 2, or more losses and age ≥ 35 years 
  • 2, or more losses after IVF
• Risk Factors

  There are several factors that make miscarriage more likely: 

  • Age – The older you are, the more likely you are to have a miscarriage. This is because as you get older, the quality of your eggs declines. Miscarriages may also be more common if the father is more than 40 years old.
  • Number of previous miscarriages – people with a higher number of previous losses are more likely to have a further loss. 
  • Ethnicity – If you are of Black African or Black Caribbean background, you are more likely to have an early miscarriage. We do not fully understand at present why this is.
  • Weight – Being overweight (body mass index – BMI of more than 25) or underweight (BMI of less than 19) increases your chance of miscarriage.
  • Lifestyle – smoking, excessive caffeine and alcohol intake increase the risk of miscarriage. 
• Causes of Recurrent Miscarriage

  In this section, we have listed things that could be the reason for all 3 (or more) of your losses. Some of these can be tested for and treated.

  Abnormal chromosomes

  Chromosomes are blocks of DNA that contain instructions for your baby’s development. The most common cause of recurrent miscarriage is that your baby has developed with the wrong number of chromosomes (too many or not enough). Occasionally, the structure of the chromosome itself develops in the wrong way.  Most of the time this happens even though the parents themselves have normal chromosomes. In a small number of cases, one or both partners may repeatedly pass on an abnormal chromosome, causing recurrent miscarriage. 

  Blood clotting disorders

  Some blood clotting disorders, such as systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) may cause recurrent miscarriage. They cause ‘sticky blood’, which affects the flow of blood to the placenta and may cause clots in the placenta. If the placenta does not work properly, oxygen and nutrients can’t reach your baby. This may lead to miscarriage. 

  All women and birthing people who experience recurrent miscarriage should be offered tests for these disorders (called ‘screening for antiphospholipid antibodies’). Treatment may involve thinning the blood with aspirin and heparin therapy.

  Hormonal imbalances

  Having too many or not enough of certain hormones in your body may make recurrent miscarriage more likely.

  Problems with the thyroid have been linked to miscarriage and other pregnancy complications. Your thyroid is a gland in your neck that produces hormones. Well-controlled thyroid disease does not cause miscarriage. However, high levels of the ‘thyroid stimulating hormone’ (TSH) or the presence of thyroid antibodies, may put you at higher risk of miscarriage.

  Diabetes. If you have diabetes and it is not properly managed, then you may have a higher chance of recurrent miscarriage. Diabetes will not increase your chance of miscarriage if you manage it in the ways recommended by your doctor. We have more information on diabetes and pregnancy here.

  Prolactin is a hormone that is produced in your pituitary gland. It controls lots of bodily functions, including milk production6. If you have too much or too little prolactin, you may be at increased chance of miscarriage.

  Polycystic ovarian syndrome (PCOS)

  You have a slightly increased risk of recurrent miscarriage if you have polycystic ovarian syndrome (PCOS). We don’t yet know exactly why. More research is needed.

  The shape of your womb (uterine problems)

   An unusually shaped womb may increase your risk of recurrent miscarriage and premature birth. There are a number of ways to investigate the shape of the womb and depending on the findings, surgery may be recommended.

  Cervical weakness

  Your cervix is a ring of muscle at the base of your womb (uterus) that connects it to your vagina.  During labour it shortens and opens to allow the baby to pass through and be born. Sometimes it shortens and opens before it should (in the second or third trimester). This is called cervical weakness (sometimes called cervical incompetence or cervical insufficiency) and can cause second trimester loss (late miscarriage).

  Unexplained recurrent miscarriage

  There may be no obvious cause of your recurrent miscarriages. Each loss might have been caused by something different. Sadly, tests may not always be able to work out exactly what happened in each case. It can be difficult to be told that your recurrent miscarriages are unexplained, especially if that means there is nothing you can treat or change next time. It might help to know that most women who have had 3 unexplained miscarriages do go on to have a healthy pregnancy. 

• What will happen following referral

  A variety of investigations and blood tests will be offered to screen for the possible cause of recurrent loss. Following this an appointment will be arranged with one of our doctors to review your results and discuss a plan for your future care.

• Bereavement Support

  Patients can contact the Maternity Bereavement Team for bereavement support. The Maternity Bereavement team can be contacted on 01772 524575 Monday – Friday.

• Support services/charities:
  • Tommys - https://www.tommys.org/
  • Miscarriage UK - https://www.miscarriageuk.org/
  • Sands - https://www.sands.org.uk/support-you/how-we-offer-support/helpline
  • 4 Louis – a UK charity to support anyone going through baby loss. https://4louis.co.uk/
  • Children of Jannah - Aimed at supporting bereaved parents who are of the Muslim faith. https://www.childrenofjannah.com/
  • Dads Still Standing – a place for dads who have suffered baby loss to find support. https://www.dadstillstanding.com/
  • The Worst Girl Gang Ever – a support platform and podcast for miscarriage and baby loss https://theworstgirlgangever.co.uk
  • Twins Trust - supports all parents and carers of twins, triplets or more who have died whether it was during or after pregnancy. https://twinstrust.org/