Pregnancy Outcomes in the Recurrent Miscarriage Clinic - Is One Scan Sufficient?

Background: At present, we do not change the frequency of scanning in a subsequent pregnancy based upon the gestations of a patient’s previous miscarriages.

Objective: To audit pregnancy outcomes in the recurrent miscarriage clinic at St James’ University Hospital, Leeds, and to ascertain whether a live intrauterine gestation of ≥6/40 identified on ultrasound scan - on a background of recurrent spontaneous miscarriage at ≤6/40 previously - is a positive predictor of a successful pregnancy outcome. Do we need to keep scanning this group after a first scan if all is well?

Methods: Retrospective study of patients of the recurrent miscarriage clinic (n=101). Patients with primary or secondary recurrent spontaneous miscarriage were included. The demographics, history and pregnancy outcomes for each patient were recorded, where a successful pregnancy outcome was defined as a live birth or being discharged to another unit at ≥12/40.

Results: The overall success rate of the recurrent miscarriage clinic was 88.8%. Of the babies born as a result of the successful pregnancies in the study, 69% were male.

There was a mean of 2.4 losses at ≤6/40 gestation previously per woman. Patients who had a history of all recurrent losses at ≤6/40, who went on to have a live intrauterine pregnancy of ≥6/40 demonstrated on their first USS, all went on to have successful pregnancy outcomes.

Conclusion: Whether the gender imbalance noted is significant is not yet known and this work is ongoing.

It is important that we strive for a more streamlined and cost-effective recurrent miscarriage service. While the findings suggest that for those women who had a history of recurrent losses all at ≤6/40, who had an ongoing, live intrauterine pregnancy of ≥6/40 seen at initial ultrasound, ‘one scan is enough’, it perhaps underestimates the importance of supportive care and the reassurance gained by more frequent scanning and review in a specialist setting.