How to Organize an RPL Clinic

Recurrent Pregnancy Loss Clinic, Rigshospitalet, Copenhagen and Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark

Background: Until recently, women with recurrent pregnancy loss (RPL) were referred to clinics of general gynaecology or emergency wards for investigation, counselling and treatment of RPL.

Objectives: To provide an overview of current recommendations about the optimal organisation of clinics specialised for the management of women with RPL

Recommendations: It is important to realize that the recommendations below are not based on direct scientific evidence but on expert opinions or statements from specialist organisations. An RPL clinic should be direct open for referral of women with a history of RPL. It should offer daytime service minimum 5 days a week. It should be lead by a consultant with documented expertice and interest I RPL. The staff should be competent in transabdominal and transvaginal scanning and trained in providing emotional and psychological support. There should be a clearly defined protocol for investigating RPL couples based on the best scientific evidence. The unit should have easy access to measurement of serum-βhCG with results available the same day and serum progesterone ideally within 24 hours. There should be a separate room for grieving. The clinic should have multidisciplinary support from obstetrics-gynaecology, genetics, pathology, rheumatology and haematology departments.

Conclusions: The background for RPL is complex and partly unknown and the condition is devastating for the couples. Therefore, specialized care must be offered to these couples in the form of well-organised RPL units.