Table 7.

General outline of treatment of RSM

Background – The aetiology of RSM is multifactorial – Appropriate treatment continues to be a challenge –Tender loving care is essential – APS is the most treatable cause of RSM,but there is a scarcity of large placebo-controlled trials in women with RSM – There is norobust evidence for LDA or LDA and heparin therapy leading to an improved pregnancy outcome in inherited thrombophilia

Before pregnancy  Counselling of the couple  Psychological support  Surgery  Hysteroscopy1  Resection of uterine septum1  Repair of cervical lacerations1  Medical treatment  Assisted reproductive technology  Induction of ovulation  Metformin  Immunological treatment  IVIG  Paternal leucocytes/lymphocytes

During pregnancy  Psychological support  Surgery  Cervical cerclage  Endocrine treatment  Luteal support  Medical treatment – combinations of treatment  LDA alone  LDA + heparin  Unfractionated  LMWH  LDA + heparin + prednisolone  LDA + heparin + IVIG  LDA + IVIG  IVIG alone  Frequent antenatal visits  Monitoring of pregnancy (mother and fetus)/blood tests/supportive therapy  Transvaginal/abdominal ultrasonography

¹These procedures should be performed before another planned pregnancy.