Women should be managed for recurrent miscarriage if they have had two pregnancy losses before 20 weeks’ gestation, even if the losses are not consecutive, according to an Australian-first clinical guideline.

The RANZCOG guideline provides evidence-based recommendations around the management of pregnancy loss, including recurrent miscarriage and ectopic pregnancies.

Importantly, it defines recurrent miscarriage as at least two confirmed intrauterine miscarriages before 20 weeks’ gestation, including non-consecutive losses and regardless of whether a gestational sac was present.

The rationale is evidence pointing to little difference in outcomes for women who have two miscarriages versus three — and whether they are consecutive — when it comes to risk factors, such as antiphospholipid syndrome and carrier status causing a structural chromosomal anomaly.