Recurrent pregnancy loss clinic information

It can be heart-breaking to miscarry one baby after another. The loss of a pregnancy will affect couples in different ways For many, the next step is to seek answers. You have been given this leaflet as you are considering investigation.

This leaflet will guide you through pregnancy loss investigation, telling you about the personal information and investigations required and the areas of health and well-being to be considered as well as providing an insight into the care available. We hope this will help you to decide whether investigation into recurrent pregnancy loss is the right choice for you and provide a resource that you can refer to.

Practical advice and guidance are important, but your emotional well-being needs to be considered too. Various resources are mentioned in this leaflet, including talking therapy support services, which you might have already accessed. Please consider them if you need extra support.

Unfortunately, recurrent pregnancy loss is presently unexplained for more than 50% of couples who undertake investigation. Some testing could find conditions that are not responsible for your losses but which have an impact on your long term health. Alternatively, sometimes a cause is identified but a proven treatment is not known. We understand that this can be disappointing and distressing. If this is the outcome for you, we will offer an individualised plan of reassurance scans and support through our dedicated Early Pregnancy Unit.

Research suggests that provision of supportive care through a specialist unit can increase the chance of a successful pregnancy. At Addenbrooke’s, 80% of couples have had a baby with their first or second pregnancy following recurrent pregnancy loss clinic attendance.

The government has launched a voluntary scheme to allow parents to record and receive a certificate to provide recognition of their loss. If you would like a certificate, you can request one by searching on the Government website.

Next steps

In the UK, recurrent miscarriage means having 2 or more miscarriages, even if you have healthy pregnancies in between. If you have had 2 or more miscarriages, you can be referred to the Recurrent Pregnancy loss clinic by your GP, another hospital or you can self-refer via Clinic 24.

Referral to Clinic 24 through the (Early Pregnancy Unit)

If you have attended Clinic 24 with recurrent pregnancy loss, you will have been offered further investigation. This leaflet will provide information to help you decide if this is the right choice for you. If you would like to proceed, you need to wait until your urine pregnancy test is negative, which can take up to three weeks following a pregnancy loss.

Most early pregnancy losses happen due to chromosomal reasons. You may have been offered cytogenetic testing on the pregnancy tissue. Cytogenetic testing looks into the chromosomes which provide a reason for the pregnancy loss. Currently this test is offered on the NHS if you are suffering a 3rd pregnancy loss. If you would like to consider self-funded testing, please discuss this with the Clinic 24 team.

Once you have a negative urine pregnancy test, contact Clinic 24 to schedule an appointment for blood test investigations. It is better if you attend as a couple, as blood tests are sometimes needed from partners, too. The team in the early pregnancy unit will let you know if you are eligible for this.

You will have blood tests taken, be given questionnaires to complete and a consultation appointment will be arranged; you will receive the details via ‘MyChart’. If the unit is busy, following your discussion with a nurse, we might ask you to attend the nearby phlebotomy department for your blood tests.

The questionnaires need to be completed and brought with you to your consultation appointment. Alternatively, you can complete it during your appointment and give it to your nurse, who will arrange for them to be scanned into your notes. The questionnaire covers your previous medical and surgical history, your pregnancy history, any current medications and your lifestyle. Please try to complete the questionnaires as soon as you can. This gives you an opportunity to reflect on your responses, especially regarding lifestyle. Later in this leaflet there is advice regarding maintaining a healthy lifestyle for conceiving and continuing pregnancy. If you feel that you can start to improve your lifestyle, please try as soon as possible.

Your consultation appointment will be scheduled to ensure that all your results are available. At this appointment you will be seen by the Lead Consultant, a Specialty Registrar or a Specialist Nurse. Your test results, questionnaire responses and history will be discussed. If you have any investigation results from other hospitals, please bring copies with you.

The appointment aims to provide you with an individual care plan. This plan is always made with consultant level input, even if you are seen by another member of the team. If follow-up consultations, referrals or investigations are needed, these will be arranged.

Following a miscarriage, if you would like, we can arrange a telephone follow-up consultation around 3 weeks after you last face-to-face appointment. It is your choice if you would like this to be arranged. If your partner would like support, please let us know. You can contact Clinic 24 at any time.

Referral from your GP or another hospital/Early pregnancy unit

If you have seen your GP about recurrent pregnancy loss you may have been referred for further investigation. This leaflet will provide you with the specialised information and act as a resource.

You will be referred for a consultation appointment for which you will receive the details via MyChart. At the appointment you will be seen by the lead consultant, a specialty registrar or a specialist nurse. You will be asked about your previous medical and surgical history, your pregnancy history, any current medications and your lifestyle. If you have any investigation results from other hospitals, please bring copies with you. You will be given initial advice and any necessary investigations will be discussed. Blood tests will need to be arranged, and you will be asked to attend the nearby phlebotomy department for these. It is better if you can attend as a couple, as general information and blood tests might be required from both partners.

When all your results are available, the lead consultant will provide an individual care plan. You will usually receive this information by post. If follow-up consultations, referrals or investigations are needed, these will be arranged.

The investigations and possible further care

You can choose if you want all or some of these investigations.

For both partners

• Chromosome analysis

To identify your chromosomes, we will need a blood sample from you and your partner. This test takes approximately eight weeks to process. This test will be offered if the lab has been unable to obtain a result from the cytogenetic tests on the pregnancy tissue or if the test showed an anomaly which could have resulted from parental genetic variations. If this is not the case, unfortunately, this test will only be offered if you have had 5 or more miscarriages.

If you have further questions about this, please do not hesitate to contact the early pregnancy unit.

Up to 3% of couples with recurrent pregnancy loss will have some sort of underlying condition. This might not cause a problem to the individual but can cause pregnancy loss. If you are identified as having a chromosomal issue, we will refer you to a clinical geneticist who will provide you with specialist counselling and advice.

All the following investigations are for the female only

• Antiphospholipid syndrome blood test

This tests for a condition which makes your blood more likely to clot.

To be diagnosed with antiphospholipid syndrome, you need two positive tests at least twelve weeks apart before you become pregnant again. Treatment is with low-dose aspirin tablets and low molecular weight heparin injections, (blood thinning injections).

Having antiphospholipid syndrome means that you are at increased risk of complications in later pregnancy, so you will therefore be monitored closely. Your obstetric and midwifery teams will provide you with more information about this.

• Diabetes and thyroid dysfunction blood tests

These test for disorders of the endocrine system. Uncontrolled diabetes or untreated thyroid disorders increase the chance of pregnancy loss. However, well controlled diabetes and treated thyroid problems do not cause recurrent pregnancy loss. We will discuss treatment with you depending on your medical history and your results.

• Vitamin D blood test

This is a vitamin that we produce from direct sunlight on the skin when outdoors. Lack of vitamin D has been linked to recurrent pregnancy loss.

Treatment is with high dose vitamin D supplements and an increase of vitamin-rich foods.

• Ultrasound scan

Problems in or with the uterus (womb) can contribute to recurrent pregnancy loss. Most women will have had an ultrasound scan at some point. If indicated, an ultrasound scan might be performed at your consultation or at a separate appointment in the Radiology Department.

Repeating tests

Occasionally, a blood test needs to be repeated. If you need a further blood test, you will usually be notified via MyChart with details of the time and location. This might require your consultation appointment to be rescheduled. We appreciate that this delay may be disappointing but reassure you that this will enable us to provide you with an accurate and personalised care plan.

Research

As previously mentioned, some results do not have proven treatment options available. You might be eligible to participate in research studies trying to find answers and treatments. This is an opportunity to maybe improve your outcome, but also to shape the future of medicine and help couples in a similar situation to you.

Participation is always voluntary. If you decide that research is not for you, it will not alter the care you receive.

We have a dedicated research team who can answer any additional questions you might have if you are approached as being eligible to participate in one of our studies.

What you can do in preparation

As previously mentioned, health and wellbeing play an important role in achieving and continuing pregnancy. Diet, exercise, smoking and alcohol consumption are areas in your lives that you and your partner are both in control of; areas where you can both make positive changes.

Consider your diet. Try to eat a balanced diet aiming for your five-a-day intake of fruit and vegetables and limit caffeine consumption to 200mg per day (two cups of regular coffee).

Exercise should be considered in relation to weight loss, but also as part of a healthy lifestyle. Our advice is 30 minutes of increased physical activity a day. When trying to conceive, keep exercise at normal levels for you. In pregnancy

avoid high impact sport, contact sport and scuba diving. If you would like a target weight, please contact the Early Pregnancy Unit.

Smoking, active and passive, could have a negative impact on the chances of a successful pregnancy, so you should think about giving up smoking. There is help and support available through your GP, local stop smoking services, online and through email (please refer to sources of support and information later in this leaflet). Vaping is believed to have a negative effect on pregnancy, however there is less research in this area.

Recreational drugs should be stopped.

No alcohol consumption is ideal. If you drink alcohol it should be limited to one to two units once or twice per week.

Women should take folic acid supplements before and during early pregnancy. The dose is dependent on your medical history and your BMI.

Men should avoid toxic chemicals in the workplace and keep things cool ‘down there’. This can be achieved by wearing loose cotton underwear, avoiding long hot baths, avoiding sitting for long periods of time and avoiding using a laptop on your lap. As each sperm takes three months to form, ideally following these suggestions should become your normal way of life.

One of the factors most related to pregnancy loss is age. There is nothing anyone can do about this. But you might want to consider it in making the decisions which are best for you.

Finally

If you decide that further investigation is not the right route for you, we can offer reassurance scans and support. As mentioned before, this can increase your chances of a successful pregnancy.

If you become pregnant before you have started investigations or during investigations, please contact Clinic 24 and we can arrange early scans for you.

Additionally, this service can be accessed if you wish by contacting the Early Pregnancy Unit or by referral through your GP.

If you would like further advice, please contact Clinic 24 or access some of the support/information providers and further resources detailed below.

Further advice, support and resources

Clinic 24 (The Early Pregnancy and Emergency Gynaecology Unit)

The Rosie Hospital, Robinson Way, Cambridge, CB2 0SW
(part of the Cambridge Biomedical Campus)
01223 217636

We are open seven days a week (excluding bank holidays). Our opening times are:
Weekdays: 08:30-20:00 (8:30am to 8pm)
Weekends: 08:30-14:00 (8:30am to 2pm)
Bank holidays: closed

Other sources of support and information

Miscarriage Association (opens in a new tab)

17 Wentworth Terrace, Wakefield, WF1 3QW
01924 200799 / Email the Miscarriage Association

The Miscarriage Association provide a telephone helpline, a volunteer support service, an online support forum and a range of helpful leaflets on all aspects of miscarriage. The online support forum has a special area for recurrent pregnancy loss.

Petals (Pregnancy Expectations Trauma and Loss Society) (opens in a new tab)

0300 688 0068 / Email Petals

Petals is a counselling charity based at our hospital. They offer six free sessions which you can attend as individuals or as a couple.

British Association for Counselling and Psychotherapy (opens in a new tab) (BACP)

BACP House, 15 St John’s Business Park, Lutterworth, LE17 4HB
0870 443 5252

The BACP is an association that will help you to find a counsellor or psychotherapist.

Health and wellbeing advice

NHS website: NHS Live Well (opens in a new tab)
Stop smoking service: NHS Better Health Quit smoking (opens in a new tab) / 0300 123 1044

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one-to-one care is required.