Recurrent Pregnancy Loss

For the couple who have had two or more miscarriages. Since 2025, RANZCOG defines recurrent miscarriage as two or more losses up to 20 weeks, so assessment can start after the second. This guide follows the RANZCOG guideline and the ESHRE guideline on recurrent pregnancy loss.

Record their pregnancies and both families, enter the tests done so far, and the guide sets out what to investigate, what is not worth testing, when chromosome testing of the couple or the pregnancy tissue helps, and the plan for the next pregnancy, with a summary for your notes or a referral.

When the guide suggests referral, or a chromosome rearrangement is found, refer to us. Tick Format as referral above the summary and it is set out as a referral letter to either of us, ready to paste into your practice software.

What it covers

The work-up recommended after two or more miscarriages in the RANZCOG guideline on miscarriage, recurrent miscarriage and ectopic pregnancy (2025): antiphospholipid antibodies, thyroid function and TPO antibodies, and a 3D ultrasound of the uterus. It shows when karyotypes for the couple are worth doing, what a pregnancy tissue result means, which tests are not recommended, and the plan for the next pregnancy, including progesterone when there is bleeding and treatment for antiphospholipid syndrome.

Questions it answers

  • When should recurrent miscarriage be investigated?

  • Which tests are recommended after two miscarriages?

  • Should the couple have karyotypes?

  • Should pregnancy tissue be tested after a miscarriage?

  • Should she take progesterone in the next pregnancy?

  • Are thrombophilia or natural killer cell tests worth doing?