Aetiology of recurrent miscarriage and the role of adjuvant treatment in its management: a retrospective cohort review.

We conducted a retrospective review into the role of commonly prescribed conventional adjuvant treatments in improving live birth rates after recurrent miscarriage (RM). Data from 301 couples attending the RM clinic in two Tertiary teaching hospitals were analysed with their live birth rate following a further pregnancy and a prevalence of conditions investigated in RM being the main outcomes measured. We found that 26% of women had explained RM and 74% had unexplained RM. Adjuvant versus conservative management did not improve the live birth rates in those with unexplained RM (68.4% vs. 76.6%, respectively; p = .28). The prevalence of anti-phospholipid syndrome, inherited thrombophilia, thyroid disease, parental karyotype abnormalities and structural uterine abnormalities were 7.4%, 4.5%, 6.6%, 2.9% and 6.6%, respectively. In conclusion, empirical adjuvant treatment for the management of women with unexplained RM does not appear to offer any benefit as they have a good prognosis with early pregnancy support alone. Impact statement What is already known on this subject? Does the adjuvant treatment in the management of unexplained recurrent miscarriage (RM) improve successful pregnancy outcomes? High-quality data regarding the management and outcomes of RM is very limited, with many clinicians prescribing adjuvant treatments for unexplained RM with very little good quality evidence of their benefit or risk. What do the results of this study add? We carried out a retrospective cohort study of all patients attending a recurrent miscarriage clinic over a two-year period at specialist clinics in two tertiary referral centres to evaluate the prevalence of associated diseases, the treatments given and the outcomes in subsequent pregnancies. This study will help clinicians counsel their patients about management options in RM and help them reassure their patients that the prognosis with conservative management alone is good. This will help to avoid any unnecessary use of adjuvant treatment and its associated risks and cost. What are the implications of these findings for clinical practice and/or further research? This study demonstrates that adjuvant treatments in unexplained RM have no significant benefit on future live birth rates. Despite this finding, high quality, prospective, randomised controlled trials looking at both adverse outcomes and benefits of adjuvant treatment in RM are needed.