Guides for practitioners. Recurrent miscarriage: principles of management
Author: Li, TC
Source: Human Reproduction, Volume 13, Number 2, February 1998 , pp. 478-482(5)
Publisher: Oxford University Press
Abstract:Recurrent miscarriage is a heterogeneous condition which has many possible underlying causes. Ideally, couples with the problem should be managed in a dedicated miscarriage clinic, with thorough investigations according to a protocol, with structured history and investigation sheets. Counselling is an important feature and may be provided by a specially trained counsellor, or specialized nurse appropriately trained in counselling. Counselling should include an explanation of the possible underlying causes of the condition, and of the prognosis of each of the conditions. There is no definite cause of miscarriage in approximately half of the patients. No treatment is needed in this group, apart from reassurance and tender loving care. Treatment of unproven value, for example progesterone support in early pregnancy, should not be offered. Treatment offered empirically or as part of a research project should have a sound scientific and statistical basis, and should include careful counselling with informed consent of the patient. There are many controversial issues in the management of recurrent miscarriage; consequently, there is a need for locally agreed guidelines for management. Women who conceive again should be offered regular monitoring, including serial ultrasonography in the first trimester of pregnancy. An active audit programme to review regularly the various outcome measures set against defined targets should be established in the clinic.
Document Type: Research Article
Publication date: 1998-02-01
- Human Reproduction features full-length, peer-reviewed papers reporting original research, clinical case histories, as well as opinions and debates on topical issues. Papers published cover the scientific and medical aspects of reproductive physiology and pathology, endocrinology, andrology, gonad function, gametogenesis, fertilization, embryo development, implantation, pregnancy, genetics, genetic diagnosis, oncology, infectious disease, surgery, contraception, infertility treatment, psychology, ethics and social issues. The highest scientific and editorial standard is maintained throughout the journal along with a rapid rate of publication.