Recurrent miscarriage

After repeated pregnancy losses, you can ask your clinician about tests and support. UK and US guidance use different definitions, but a clinician may offer tests before you meet the formal definition.

The UK and US definitions differ

RCOG defines recurrent miscarriage as three or more first trimester miscarriages. They do not have to happen in a row: there may be a successful pregnancy between losses. The guideline also allows clinicians to recommend investigation after two first trimester miscarriages if they suspect an underlying problem rather than separate chance events.

In the US, ACOG defines recurrent pregnancy loss as two or more miscarriages and recommends a thorough examination and testing after two. Ask your GP or obstetric clinician what assessment is appropriate for your history.

You can ask for support however many losses you have had. At an appointment, you can talk about grief, anxiety and the effect on everyday life alongside questions about physical care.

What the appointment may cover

Your clinician may ask about previous pregnancies and your medical history, and may offer a physical examination. Bring any dates, scan reports or treatment details you already have. A short account is enough to start with. Leave gaps where you are unsure.

Tests look for possible explanations and can include blood tests for antiphospholipid syndrome, known as APS, and thyroid problems. Diabetes testing may be offered when your history suggests it is relevant. A pelvic ultrasound can look at the shape of the uterus, or womb.

Genetic testing may involve pregnancy tissue or, in certain circumstances, you and a partner. RCOG describes offering pregnancy testing at a third or further miscarriage and considering parental tests when tissue cannot be tested or the findings suggest an inherited problem. Ask what a test could tell you and whether it would change care.

What treatment can and cannot promise

Treatment depends on what is found. For people with APS and recurrent miscarriage, a specialist may prescribe aspirin and heparin during pregnancy. These medicines are not a general treatment to try after any loss. Your doctor can explain whether these medicines are suitable for you and how they are prescribed.

Diabetes or thyroid disease may need attention before another pregnancy. Some womb conditions may lead to a discussion about surgery, and an inherited chromosome finding may lead to genetic counselling. The benefit of an operation depends on the condition; surgery for fibroids has not been shown clearly to reduce miscarriage risk.

RCOG finds no evidence that progesterone prevents recurrent miscarriage unless there is bleeding in early pregnancy. If you have bleeding in a new pregnancy, tell the clinician about your previous losses so they can assess whether progesterone is appropriate. Do not self-treat the bleeding.

When tests do not find a cause

Often, tests do not find a cause. RCOG says there is no current evidence that medical treatment reduces further miscarriage in unexplained cases. A future successful pregnancy remains possible, but your outlook depends on your age, previous losses and investigation results. Ask your clinician to explain what is still uncertain.

If you want another pregnancy, discuss a support plan before trying again: who to contact after a positive test, what scans may be offered and where to get help between appointments. You may also decide to pause or not try again.

Care now, and support with loss

Call 999 now (UK) or 911 (US), or your local emergency number, for heavy bleeding in pregnancy, or if pregnancy is possible and you have sudden severe tummy pain, shoulder-tip pain, marked weakness or fainting, even without vaginal bleeding. Contact your pregnancy unit or NHS 111 in the UK, your obstetric clinician in the US, or your local pregnancy service today for lighter bleeding or fluid leaking. A referral for investigations does not replace care for current symptoms.

Repeated loss can affect mental health, including anxiety, depression or post-traumatic stress. Book an appointment with your GP or doctor if you need support; a partner can ask for support too.

For urgent mental health support, call NHS 111 and select the mental health option in England, or contact your local urgent mental health service elsewhere. In the UK, you can call Samaritans on 116 123. In the US, call or text 988.

Call 999 now (UK) or 911 (US), or your local emergency number, if you cannot keep yourself safe or there is immediate danger to life.