Guideline No. 464: Recurrent Pregnancy Loss.

OBJECTIVE: The object of this guideline is to provide clinicians with the most up to date evidence available for the evaluation and management of patients with recurrent pregnancy loss. TARGET POPULATION: Patients with Recurrent Pregnancy Loss (defined as two or more pregnancy losses.) OPTIONS: Strategies for managing RPL includes lifestyle changes (reducing caffeine, smoking, alcohol), addressing obesity, screening for thyroid dysfunction, diabetes, antiphospholipid syndrome, and treating uterine anomalies like septate uterus or adhesions. Chronic endometritis may benefit from antibiotics. Genetic testing of gestational tissue and parental karyotyping can identify chromosomal issues. Treating acquired thrombophilias may be beneficial. Progesterone therapy may be helpful, especially if started in the luteal phase. Access to early pregnancy assessment clinics, emotional support, close monitoring, and trauma-informed care are essential, with empirical treatments used cautiously due to limited evidence. OUTCOMES: Pregnancy loss rate, Live birth rate BENEFITS, HARMS, AND COSTS: Improved live birth rates and providing etiological answers to affected patients. Patients will sacrifice time and experience the discomfort of investigations with a high probability of negative results. The financial costs of investigations are covered by medical plans, but some of the therapies are uninsured and expensive. Investigations should be done according to evidence-based recommendations and accessible to all women. EVIDENCE: English-language articles were searched from January 1, 2008 to June 30, 2025 in PubMed, Cochrane Library, CINAHL, MEDLINE, Embase and Scopus using the broad search terms habitual abortion, abortion, recurrent abortion, recurrent miscarriage, recurrent early pregnancy loss, recurrent pregnancy loss, idiopathic pregnancy loss, idiopathic recurrent miscarriage. VALIDATION METHODS: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE: All healthcare professionals who care for patients with Recurrent Pregnancy Loss. ABSTRACT FOR SOCIAL MEDIA: Recurrent Pregnancy Loss (RPL) is defined as two or more pregnancy losses, including non-consecutive and biochemical. Causes range from chromosomal and anatomical to endocrine, immune, infectious, and lifestyle factors-though most remain unexplained. Evaluation and personalized care are essential. While evidence for treatments varies, trauma-informed care, shared decision-making, and equitable access to investigations across the country are critical. SUMMARY STATEMENTS: RECOMMENDATIONS.