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Recurrent miscarriage : evidence to accelerate action
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(2021) Recurrent miscarriage : evidence to accelerate action. Lancet, 397 (10285). pp. 1675-1682. doi:10.1016/S0140-6736(21)00681-4 ISSN 0140-6736.
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Official URL: https://doi.org/10.1016/S0140-6736(21)00681-4
Abstract
Women who have had repeated miscarriages often have uncertainties about the cause, the likelihood of recurrence, the investigations they need, and the treatments that might help. Health-care policy makers and providers have uncertainties about the optimal ways to organise and provide care. For this Series paper, we have developed recommendations for practice from literature reviews, appraisal of guidelines, and a UK-wide consensus conference that was held in December, 2019. Caregivers should individualise care according to the clinical needs and preferences of women and their partners. We define a minimum set of investigations and treatments to be offered to couples who have had recurrent miscarriages, and urge health-care policy makers and providers to make them universally available. The essential investigations include measurements of lupus anticoagulant, anticardiolipin antibodies, thyroid function, and a transvaginal pelvic ultrasound scan. The key treatments to consider are first trimester progesterone administration, levothyroxine in women with subclinical hypothyroidism, and the combination of aspirin and heparin in women with antiphospholipid antibodies. Appropriate screening and care for mental health issues and future obstetric risks, particularly preterm birth, fetal growth restriction, and stillbirth, will need to be incorporated into the care pathway for couples with a history of recurrent miscarriage. We suggest health-care services structure care using a graded model in which women are offered online health-care advice and support, care in a nurse or midwifery-led clinic, and care in a medical consultant-led clinic, according to clinical needs.
Item Type: | Journal Article | ||||||||
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Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RG Gynecology and obstetrics |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School | ||||||||
SWORD Depositor: | Library Publications Router | ||||||||
Library of Congress Subject Headings (LCSH): | Miscarriage, Miscarriage -- Treatment, Medical care -- Great Britain | ||||||||
Journal or Publication Title: | Lancet | ||||||||
Publisher: | The Lancet Publishing Group | ||||||||
ISSN: | 0140-6736 | ||||||||
Official Date: | 1 May 2021 | ||||||||
Dates: |
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Volume: | 397 | ||||||||
Number: | 10285 | ||||||||
Page Range: | pp. 1675-1682 | ||||||||
DOI: | 10.1016/S0140-6736(21)00681-4 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||||
Date of first compliant deposit: | 30 August 2023 | ||||||||
Date of first compliant Open Access: | 30 August 2023 | ||||||||
RIOXX Funder/Project Grant: |
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