Treatment Of Recurrent Miscarriage
When Antiphospholipid Syndrome has been diagnosed
Aspirin 75-80 mg per day
Clexane or equivalent 20mg subcutaneously daily
The treatment should start when the fetal heart has been seen on ultrasound at 6 weeks. It is not appropriate to start Clexane before this time although aspirin can be started earlier. We can teach you to self-inject Clexane. It needs to be given daily. Treatment should be continued until at least 34 weeks of pregnancy. Your Obstetric Consultant will advise you as to how long after that you should continue.
When Thrombophilia has been diagnosed
Take oral Aspirin 75-80mg daily. This can be started as soon as pregnancy is diagnosed
High LH and Polycystic ovaries
There is some poor quality research that suggests that giving hCG injections improve outcome. Given that there is no contrary information we advise that if you have suffered recurrent miscarriage and your LH measured on around day 8 of your cycle is raised you should have hCG 5000 iu twice weekly until 12 weeks gestation.
Immune origin
The diagnosis is often difficult however if there is good evidence then treatment is with Prednisolone 5mg -15mg twice a day. It may increase the risk of high blood pressure, diabetes and premature birth. Intravenous immunoglobulin therapy has been used to change the immune system but is highly expensive with uncertain outcomes. Side effects are rare but can include headache, muscle pain, fever, chills, low back pain, thrombosis (blood clots), kidney failure and anaphylaxis. Intralipid has been used as a cheaper alternative but currently the President of the Royal College of Obstetricians and Gynaecologists has written to all gynaecologists expressing concern regarding this product and its ‘off label’ use
No treatable abnormality
The pregnancy rate seems to improve with regular surveillance scanning. We would recommend that you have a viability scan at 6-7 weeks gestation and then every 2 weeks in the first trimester.