Management of recurrent miscarriage: a guide for GPs
Few clinical situations in general practice are as emotionally demanding - for patients and practitioners alike - as
recurrent miscarriage. For patients who are desperate to start or expand their family, each loss carries its own weight of grief, confusion and isolation. And yet, even after thorough investigation, many cases of recurrent pregnancy loss remain unexplained. There are no clear answers. No obvious pathway forward. Just the question of what to do next.
GPs occupy a uniquely important position in this journey. As the first clinical contact, the ongoing support person, and often the one ordering early investigations, a GP's response in the wake of pregnancy loss can shape how a patient understands their situation and what steps they feel empowered to take. In this episode of Fertility in General Practice, Dr Anthony Marren - Medical Director at Genea's flagship Sydney CBD clinic and certified subspecialist in reproductive endocrinology and infertility (CREI) - joins host Dr Ali Hodgkinson to help GPs navigate this challenging area with clarity and compassion.
Defining recurrent miscarriage
Recurrent pregnancy loss is generally defined as two or more consecutive pregnancy losses before 20 weeks gestation. It affects approximately one to two per cent of couples trying to conceive - a figure that may feel low in isolation but represents a significant number of Australians navigating repeated grief and uncertainty.
It is important for GPs to understand that a single miscarriage is common, occurring in up to one in five clinically recognised pregnancies, and does not in itself warrant extensive investigation. However, patients who have experienced two or more losses - or one loss with concerning features such as a structural anomaly on ultrasound or a known thrombophilia - should be considered for earlier specialist review rather than a watchful waiting approach.
What investigation looks like
When recurrent miscarriage is suspected or confirmed, a structured investigation approach helps identify treatable causes - while also preparing patients for the possibility that no clear cause will be found.
Investigations typically include chromosomal karyotyping of both partners, thrombophilia screening (including antiphospholipid antibody syndrome, which is one of the most clinically significant and treatable causes of recurrent loss), uterine assessment via ultrasound or hysteroscopy to identify structural abnormalities, and thyroid function testing. In some cases, testing for inherited thrombophilias and immune factors may also be considered, though the evidence for some of these in recurrent miscarriage is still evolving.
GPs can initiate several of these investigations before a specialist referral, which can meaningfully reduce the time to diagnosis and treatment. Antiphospholipid antibody testing (including lupus anticoagulant, anticardiolipin antibodies, and anti-beta-2 glycoprotein-I antibodies) and thyroid function are straightforward to order in the GP setting.
