2. Clinical Scenario
• 41 year old female
• Successful first time try son last year
• Same partner throughout
• One miscarriage 6w gestation 6m ago
• Now presenting with 1d Hx of fresh, stringy PV
loss
• “I would like some investigations please – time
is not on my side”
3. Epidemiology / background
• “Early loss (before 23w) of pregnancy”
• Occurred >3 times
• 1:100
• Investigations after the 3rd
4. RCOG Guideline No 17 (May 2003)
• 10-15% pregnancies result in miscarriage
• 1% are recurrent
• All women should have pelvic USS
• In asymptomatic women TFTs and fasting glucose is
uninformative
• Insufficient evidence about the use of progesterone
• APL – 2 positive results 6w apart / combination therapy
improves live birth rate
• Supportive ANC alone has high rates of future success
5. What to do?
• Communication skills:
– By definition not eligible for investigations
– Consoling / empathy
– Facts and figures
– Self-help / help groups available nationally and
locally