--- title: "Recurrent miscarriage" description: "How UK and US definitions differ, what tests may be offered, and where to find care and support after more than one loss." url: "https://myruva.co/learn/recurrent-miscarriage" language: "en-GB" topic: "Fertility" published: "2026-10-18" updated: "2026-10-19" author: "Ruva team" reading_minutes: 4 --- # Recurrent miscarriage How UK and US definitions differ, what tests may be offered, and where to find care and support after more than one loss. *Written and reviewed by the Ruva team · Updated 2026-10-19 · Fertility* ## Key points - RCOG defines recurrent miscarriage as three or more early losses. In some cases, tests are offered after two. - ACOG defines recurrent pregnancy loss as two or more miscarriages and recommends tests after two. - Tests may look at blood clotting, thyroid function, genetics and the shape of the womb. - Often no cause is found. Support and planning still matter. After more than one pregnancy loss, you can ask your clinician about tests and support. UK and US guidance define this in different ways. A clinician may offer tests before you meet the formal definition. ## The UK and US definitions differ RCOG (the UK’s Royal College of Obstetricians and Gynaecologists) defines recurrent miscarriage as three or more miscarriages in the first trimester, which is the first months of pregnancy. They don’t have to happen in a row. There may be a successful pregnancy in between. The guideline also lets clinicians suggest tests after two first trimester miscarriages. They may do this if they suspect an underlying problem rather than separate chance events. In the US, ACOG defines recurrent pregnancy loss as two or more miscarriages. It recommends a full examination and tests after two. Ask your GP or obstetric clinician which checks suit your history. You can ask for support however many losses you’ve had. At an appointment, you can talk about grief, anxiety and how this affects everyday life, as well as asking about physical care. ## What the appointment may cover Your clinician may ask about past pregnancies and your medical history, and may offer a physical examination. Bring any dates, scan reports or treatment details you have. A short account is enough to start with. Leave gaps where you’re not sure. Tests look for possible reasons. They can include blood tests for antiphospholipid syndrome (APS), a condition that makes blood more likely to clot, and for thyroid problems. You may be offered a test for diabetes if your history suggests it’s relevant. A pelvic ultrasound scan can look at the shape of the womb (uterus). Genetic testing may use tissue from the pregnancy. In some cases, it may involve testing you and a partner. RCOG says to offer tests on the pregnancy tissue at a third or later miscarriage. It says to consider testing the parents if the tissue can’t be tested or the results suggest an inherited problem. Ask what a test could tell you and whether it would change your care. ## What treatment can and cannot promise Treatment depends on what is found. For people with APS and recurrent miscarriage, a specialist may prescribe aspirin and heparin during pregnancy. These medicines aren’t a general treatment to try after any loss. Your doctor can explain whether they suit you and how they are prescribed. Diabetes or thyroid disease may need treating before another pregnancy. Some conditions of the womb may lead to a talk about surgery. A chromosome finding that runs in the family may lead to genetic counselling. Whether an operation helps depends on the condition. Surgery for fibroids has not been clearly shown to lower the risk of miscarriage. RCOG finds no evidence that progesterone prevents recurrent miscarriage, unless there is bleeding in early pregnancy. If you have bleeding in a new pregnancy, tell the clinician about your past losses. They can then decide whether progesterone is right for you. Don’t treat the bleeding yourself. ## When tests do not find a cause Often, tests don’t find a cause. RCOG says there is no current evidence that medical treatment lowers the chance of another miscarriage when no cause is found. A successful pregnancy in future is still possible, but your outlook depends on your age, past losses and test results. Ask your clinician to explain what is still uncertain. If you want another pregnancy, plan your support before trying again. Find out who to contact after a positive test, what scans may be offered and where to get help between appointments. You may also decide to take a break or not to try again. ## Care now, and support with loss Call 999 now (UK) or 911 (US), or your local emergency number, for heavy bleeding in pregnancy. Call the same number if you could be pregnant and you have sudden severe tummy pain, pain at the tip of your shoulder, marked weakness or fainting. This applies even if you have no vaginal bleeding. For lighter bleeding or fluid leaking, get help today. Contact your pregnancy unit or NHS 111 in the UK, your obstetric clinician in the US, or your local pregnancy service. Being referred for tests doesn’t replace care for symptoms you have now. Repeated loss can affect mental health. It can lead to anxiety, depression or post-traumatic stress. If you need support, book an appointment with your GP or doctor. A partner can ask for support too. For urgent mental health support in England, call NHS 111 and choose the mental health option. Elsewhere, contact your local urgent mental health service. In the UK, you can call Samaritans on 116 123. In the US, call or text 988. Call 999 now (UK) or 911 (US), or your local emergency number, if you can’t keep yourself safe or a life is in immediate danger. ## When to get help - **Emergency:** Call 999 now (UK) or 911 (US), or your local emergency number, for heavy bleeding in pregnancy. Call the same number if you could be pregnant and you have sudden severe tummy pain, pain at the tip of your shoulder, marked weakness or fainting. This applies even if you have no vaginal bleeding. - **Emergency:** Call 999 now (UK) or 911 (US), or your local emergency number, if you can’t keep yourself safe or a life is in immediate danger. - **Same day:** Contact your maternity or early pregnancy unit, or NHS 111 (UK), your obstetric clinician (US), or your local pregnancy service today for bleeding or fluid leaking during a current pregnancy. - **Book an appointment:** Book a GP appointment (UK), or see your obstetric clinician (US and elsewhere), to talk about tests and emotional support after more than one pregnancy loss. ## Where you live Services and advice differ between countries. - **UK:** RCOG uses three or more miscarriages in the first trimester (the first months of pregnancy), which don’t have to be in a row. Clinicians may offer tests after two if they suspect an underlying cause. - **US:** ACOG uses two or more miscarriages and recommends a full examination and tests after two. - **Elsewhere:** Definitions and referral routes differ. Ask your local clinician when tests are right for you rather than assuming the UK or US definition applies. ## Sources 1. [Recurrent miscarriage](https://www.rcog.org.uk/for-the-public/browse-our-patient-information/recurrent-miscarriage/), Royal College of Obstetricians and Gynaecologists 2. [Recurrent Miscarriage (Green-top Guideline No. 17)](https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/recurrent-miscarriage-green-top-guideline-no-17/), Royal College of Obstetricians and Gynaecologists 3. [Repeated Miscarriages](https://www.acog.org/womens-health/faqs/repeated-miscarriages), American College of Obstetricians and Gynecologists 4. [Miscarriage](https://www.nhs.uk/conditions/miscarriage/), NHS 5. [Where to get urgent help for mental health](https://www.nhs.uk/nhs-services/mental-health-services/where-to-get-urgent-help-for-mental-health/), NHS 6. [Talk to us on the phone](https://www.samaritans.org/how-we-can-help/contact-samaritan/talk-us-phone/), Samaritans 7. [Contact Us](https://988lifeline.org/contact-us/), 988 Suicide & Crisis Lifeline 8. [Ectopic Pregnancy](https://www.acog.org/womens-health/faqs/ectopic-pregnancy), American College of Obstetricians and Gynecologists --- This guide is general information to help you keep and use your own records. It isn’t medical advice. If you’re worried about a symptom, or something changes suddenly, talk to a doctor, nurse or pharmacist.