Investigation and management of recurrent miscarriage

Recurrent miscarriage is traditionally defined as three or more consecutive miscarriages and this occurs in approximately 1% of couples trying to conceive. In most couples no pathological cause is identified. The outcome can be improved for women with recurrent miscarriage and antiphospholipid syndrome with treatment with aspirin and/or heparin. Couples with unexplained recurrent miscarriage have an excellent prognosis with supportive care alone and to date no pharmacological intervention has been proven to be beneficial. This review describes the causes of recurrent miscarriage, the clinical work-up and an evidence-based approach to management.