Is recurrent miscarriage a useful clinical concept?

Abstract

Many treatments have been used to increase the chances of an ongoing pregnancy after recurrent miscarriage (RM). Yet no clear evidence for an effective intervention has been found. Therefore, the clinical concept RM should be reconsidered. Both the statistical and clinical bases for RM are poor. If the individual risk is taken into account, then simple calculations explain the observed frequency of RM. Most miscarriages, either sporadic or recurrent, are abnormal in construction or development. Although some risk factors for miscarriage have been identified, such as age and number of previous miscarriages, the importance of other factors remains uncertain. RM has a favorable prognosis: the cumulative live birth rate is usually over 90% after two or three more attempts. So maternal systemic pathology does not seem to play a major role in the cause of RM. Little benefit can be expected from any intervention aimed at increasing the chance of a live birth. RM does not appear to be a real pathological entity that requires a special explanation. Moral support should replace medical interventions in most cases.