Clinical reference

Recurrent miscarriage

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class WD65.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Recurrent Pregnancy Loss - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK554460/

Verified against3 documents

No dose - referral pathway, no medicine given in primary care
Recurrent miscarriage - disease-level clinical article (recurrent-miscarriage-full.txt)
Recurrent miscarriage - disease-level clinical article (recurrent-miscarriage-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (2)

Losses tend to recur around the same point in pregnancy each time, so the exact gestational age of each prior loss should be documented.
A prior D&C raises the risk of Asherman syndrome or cervical incompetence, either of which can drive further loss.

Tests (8)

Diabetes, thyroid disease, and elevated prolactin should be excluded with appropriate blood work.
Karyotyping both partners can uncover a balanced translocation or mosaicism, although the yield is low and cost is a factor.
Pelvic ultrasound, saline sonohysterography, hysterosalpingogram, hysteroscopy, or MRI can identify a contributing uterine anomaly.
Testing should look for lupus anticoagulant plus antibodies against cardiolipin and beta-2 glycoprotein, the antiphospholipid panel.
Checking progesterone levels routinely isn't recommended, since it doesn't predict how a future pregnancy will go.
Endometrial biopsy isn't a useful test here, since studies show it doesn't reflect a woman's fertility status.
Routine screening for chlamydia, gonorrhea, bacterial vaginosis, or TORCH infections isn't helpful in an otherwise well woman with recurrent loss.
Genetic testing of tissue from the second and later miscarriages is recommended, and combined with standard workup finds a probable cause in over 90 percent of cases.

If not this — what else fits (2)

A chromosomal problem in the fetus is the most commonly identified cause, alongside cases where no cause is ever found.
Less often, antiphospholipid syndrome, cervical incompetence, a parental chromosomal issue, or poorly controlled diabetes are behind the losses.

SourceStatPearls "Recurrent Pregnancy Loss" - disease-level clinical article

Presentation findings are traced to the source above.

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line

Adult dose and duration

Recurrent, consecutive miscarriages warrant referral for specialist work-up of underlying causes such as anatomical, endocrine, autoimmune, or genetic factors. - Refer, with advice

Paediatric dose

Adult-only condition - paediatric section not applicable

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Recurrent, consecutive miscarriages warrant referral for specialist work-up of underlying causes such as anatomical, endocrine, autoimmune, or genetic factors.

Cautions

RED FLAG - Antiphospholipid syndrome presenting with arterial/venous thrombosis: assess urgently and refer.
Recurrent second-trimester loss may indicate cervical insufficiency needing specific obstetric management.
No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
RED FLAG - Antiphospholipid antibody syndrome (present in 8-42% of RPL cases) increases the risk of maternal thrombosis and placental insufficiency.
RED FLAG - Recurrent pregnancy loss carries a severe psychological impact and is associated with depression, anxiety, and low self-esteem.

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