Recurrent Miscarriage
Miscarriage is the commonest complication of pregnancy and accounts for the majority of acute female presentations to primary and secondary health care services in the UK. At least 25-50% of all women will experience one or more early miscarriages before 10 weeks of gestation. Many of these are due to embryo/fetal chromosomal abnormalities , the incidence of which increases with rising maternal age.
Recurrent miscarriage (RM) defined as > 3 consecutive pregnancy losses affects 1% of couples trying to achieve a live baby - approx 6000 couples in UK. RM is accompanied by significant psychological morbidity and consumes £30million of UK health care resources annually.
The dedicated Recurrent Miscarriage Clinic (RMC) at St Mary’s receives 1000 new referrals per year and is the largest tertiary referral service in the world. The clinic is a valuable research and training resource and has developed a reputation for performing only evidence based investigations and conducting rigorous treatment trials.
Our database contains over 12,000 carefully phenotyped patients and their subsequent pregnancy outcomes. This unique resource has been used to create evidence based guidelines for the investigation and treatment of RM that have been adopted nationally and internationally. We have particular expertise in management of women with a history of late miscarriage and stillbirths. Our bench to bedside translational research programme has featured widely in the media.
The database is complimented by a large pregnancy tissue archive of trios –maternal and paternal blood samples together with fetal/placental/cord / buccal swab samples from subsequent pregnancies, together with luteal phase (implantation) endometrial biopsies from RM women with ≥ 5 miscarriages. This trio collection has recently been expanded further with the award of funding to Professor Lesley Regan (Imperial) and Professor Gudrun Moore (University College) from Wellbeing of Women to launch the Baby Bio Bank project . This collaboration will establish a national archive of trio samples over the next 5 years for the 4 main complications of pregnancy: recurrent miscarriage, pre-eclampsia, fetal growth restriction and premature birth. This valuable resource will be made available to other researchers in the field ensuring that reproductive research in these areas can be fast tracked in the future.
As European lead centre for antiophospholipid syndrome (aPL) in pregnancy, we determined that combination therapy of aspirin and heparin transforms the live birth rate from 10 to 75%: and this intervention has now become the gold standard of treatment. Studies of the deleterious effects of aPL on human trophoblast and decidual function have led to imporved understanding of the mechanisms of pregnancy loss. Recent studies have highlighted the importance of pro-inflammatory disorders and abnormal reproductive haemostasis as the most important treatable cause of recurrent miscarriage and later pregnancy complications. The finding that many cases of RM result from prothrombotic tendencies that are detectable in the non pregnant state has led to our developing cheap near bedside predictive tests to identify those women at risk of pregnancy complications. Importantly, many of these women appear to be at increased risk of cardiovascular disease in later life and can be identified during their reproductive years and offered long term preventative measures.
