Recurrent Pregnancy Loss: A Complete UK Guide
Recurrent pregnancy loss (RPL), sometimes called recurrent miscarriage, is defined in the UK as the loss of three or more consecutive pregnancies. It affects around 1% of couples trying to conceive. It is heartbreaking, but there is hope — investigation and treatment help many people go on to have a healthy baby.
What counts as recurrent pregnancy loss
The UK definition is three or more consecutive first-trimester losses, or two or more second-trimester losses. After three losses, the NHS offers investigation. You can ask for referral earlier if you are anxious, particularly after two losses or if you are over 35.
Causes
In around half of cases, no cause is identified — which is frustrating but also means there is no barrier to a successful pregnancy. Known causes include:
Chromosomal factors
- Parental chromosome rearrangements (balanced translocations) in around 2-5% of couples with RPL
- Foetal chromosomal abnormalities, more common with increasing age
Antiphospholipid syndrome (APS)
An autoimmune clotting disorder found in around 15% of women with RPL. It is treatable.
Inherited thrombophilias
Blood clotting disorders that may contribute to loss, particularly in later pregnancy.
Anatomical factors
- Cervical weakness (incompetent cervix)
- Uterine abnormalities — septate uterus, bicornuate uterus, fibroids, Asherman's syndrome
Hormonal and metabolic
- Uncontrolled thyroid disease
- Uncontrolled diabetes
- PCOS (the link is debated)
Immunological and lifestyle
- Lifestyle factors — smoking, high alcohol intake, obesity
- Advanced maternal age
NHS investigations
After referral (usually to a recurrent miscarriage clinic or gynaecology), tests may include:
- Blood tests — for APS (lupus anticoagulant, anticardiolipin, beta-2 glycoprotein), inherited thrombophilias, thyroid function, diabetes
- Karyotyping — blood tests for both partners to look for chromosome rearrangements
- Pelvic ultrasound — to assess the uterus
- Hysteroscopy, HyCoSy or MRI — to examine the inside of the uterus
- Genetic tests on pregnancy tissue — if available from the most recent loss
Your team should explain each test and what the results mean.
Treatment options
Treatment depends on the cause:
- APS — low-dose aspirin plus heparin injections in pregnancy dramatically improves outcomes
- Cervical weakness — a cervical stitch (cerclage) may be offered
- Uterine abnormalities — surgery to correct a septum or remove fibroids in selected cases
- Thyroid or diabetes — optimising treatment before conception
- Progesterone — the PRISM and PROMISE trials have guided NHS use of progesterone in selected cases
- Lifestyle — stopping smoking, reducing alcohol, achieving a healthy weight
- No cause found — many couples conceive successfully with monitoring and support alone
Supportive care in a subsequent pregnancy
- Early scans for reassurance
- Continuity of carer
- A personalised care plan
- Access to an early pregnancy unit directly
Emotional support
RPL can cause profound grief, anxiety, loss of confidence and strain on relationships. Support options:
- Your GP — referral for counselling
- NHS talking therapies — self-refer
- Miscarriage Association — information and peer support
- Sands — for later losses
- Fertility support groups — for those also experiencing infertility
For partners
Partners experience RPL differently and may feel helpless. Acknowledge their grief, attend appointments, and seek support if needed.
Hope
Even after three losses, around 60-75% of women go on to have a successful pregnancy with the right care. Where a cause is found, treatment often improves outcomes significantly.
This guide is informational and not a substitute for individualised NHS care.