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Pregnancy loss

Recurrent miscarriage

It is not something you caused. And in most couples, investigation finds either a treatable reason or a genuinely reassuring answer.

Most couples who investigate go on to have a baby.

01

What it actually is

Miscarriage is far more common than most people realise — a substantial proportion of recognised pregnancies end this way, most in the first twelve weeks, and most because of a chromosomal error in that particular pregnancy that nobody could have prevented.

Recurrent loss means two or more consecutive miscarriages. Historically women were told to wait for three before anyone would investigate; increasingly, investigation is offered after two, because the tests are straightforward and the waiting is cruel. The most important thing to say plainly: this is not caused by lifting something, working too hard, an argument, or anything you ate.

Around one in four to five recognised pregnancies ends in miscarriage. Recurrent loss — two or more in a row — affects a much smaller group, and the majority of those couples go on to have a successful pregnancy.

Investigateclotting · thyroid · uterusTreat what is foundand support what isn'tTry againearly scans, close contact
Most couples who investigate go on to have a baby. Nothing you did caused this.

For general understanding only. These are drawings, including the ultrasound view — they are built from typical measurements to explain the idea, and are not real scan images or a picture of your own baby.

02

What you might notice

  • Two or more consecutive pregnancy losses
  • Losses occurring at a similar stage each time
  • A loss in the second trimester, which is investigated differently
  • Painless dilatation of the cervix in a previous mid-pregnancy loss
  • A known clotting disorder, thyroid condition or diabetes

Don't wait for an appointment if…

  • Heavy bleeding with clots and severe pain in early pregnancy — seek urgent care
  • Severe one-sided pain with a positive pregnancy test, which needs immediate assessment for ectopic pregnancy
  • Fever alongside bleeding in pregnancy
  • A second-trimester loss, which should always be investigated
03

The tests that are actually useful

Not everyone needs every test. This is what each one is for, so you know why it was ordered — or why it wasn't.

A blood testHormones, thyroid and iron — the numbers no scan can show.
An ultrasoundThe shape of the uterus, the thickness of the lining, and the follicles on each ovary.
A camera, sometimesA keyhole look inside, offered only when it would change the plan.

Not everyone needs all three. Each answers a different question — which is why a test you were not offered is often the right call.

Antiphospholipid antibodiesLupus anticoagulant and anticardiolipin antibodies. This is one of the few genuinely treatable causes of recurrent loss, which is why it is checked early.
Thyroid function and thyroid antibodiesThyroid disease affects both conception and the maintenance of a pregnancy, and correcting it is simple.
Blood sugar controlPoorly controlled diabetes increases the risk of loss. Optimising it before the next pregnancy matters.
Assessment of the shape of the uterusPelvic ultrasound, 3D imaging or hysteroscopy. A uterine septum is a structural cause that can be surgically corrected.
Parental karyotype, in selected couplesA balanced chromosomal rearrangement in one partner is uncommon but important to identify, as it changes the counselling entirely.
Testing of the pregnancy tissue, where possibleConfirming a chromosomal cause for a particular loss can spare you a long list of other investigations.
04

Treatment, in the order it's usually tried

  1. Start simpleLifestyle, pain relief, or a tablet — whatever is least disruptive to your life.
  2. Add if neededA hormonal option or a longer course, if the first step has not settled things.
  3. A procedureDay-case surgery when medicine cannot fix the structure causing the problem.
  4. Specialist routeFertility treatment or a referral, planned with you rather than sprung on you.

You move up a rung only if the one below it has not done the job — and you can stop at any step you are happy with.

Treating what is found

Aspirin and heparin for antiphospholipid syndrome; thyroid correction; blood sugar optimisation.

Where a treatable cause is identified, treating it meaningfully changes the outlook for the next pregnancy.

Surgical correction

Hysteroscopic resection of a uterine septum, or removal of a fibroid or polyp distorting the cavity.

Done as minimal access surgery where the anatomy is the identified problem.

Cervical support

Monitoring of cervical length, and a cervical stitch in selected cases.

Specifically for mid-pregnancy losses with a painless, shortening cervix.

Progesterone support

Progesterone in early pregnancy for a defined group.

Offered based on your particular history rather than to everyone. You will be told honestly what the evidence does and does not show.

Close early pregnancy care

Early scans, direct access, and someone who answers.

When no cause is found — which is common — supportive early care with frequent reassurance is itself associated with good outcomes, and it makes the waiting survivable.

05

What you were probably told that isn't true

You must have done something to cause it.
Everyday activity, work, exercise, stress and ordinary food do not cause miscarriage. The commonest cause is a chromosomal error in that pregnancy, present from the beginning.
Nothing can be done until you have had three.
Investigation after two consecutive losses is increasingly standard, and the initial tests are simple.
No cause found means no hope.
Unexplained recurrent loss carries a genuinely reasonable chance of a successful next pregnancy, particularly with supportive early care.
Complete bed rest prevents miscarriage.
Bed rest has not been shown to prevent miscarriage, and prolonged immobility carries its own risks.
Next step

Bring this to someone who has time.

A 25–40 minute consultation, on video, with a doctor who will explain what applies to you specifically — and what doesn't.

This page is general information, not medical advice. Nothing here can diagnose you or replace an assessment of your own history, examination and results. If something here matches what you are experiencing, the next step is a consultation — not a conclusion. If you are in severe pain, bleeding heavily, or feel unwell, seek urgent care rather than waiting for an appointment. Awaiting final clinical review before publication.