What is Miscarriage?
A miscarriage is the loss of a baby before the 20th week of pregnancy. The medical term for a miscarriage is spontaneous abortion. But it isn’t an abortion in the common meaning of the term.
As many as 50% of all pregnancies end in miscarriage — most often before a woman misses a menstrual period or even knows they’re pregnant. About 15%-25% of recognized pregnancies will end in a miscarriage.
More than 80% of miscarriages happen within the first 3 months of pregnancy. Miscarriages are less likely to happen after 20 weeks. When they do, doctors call them late miscarriages.
Symptoms of a miscarriage include:
- Bleeding that goes from light to heavy
- Severe cramps
- Belly pain
- Worsening or severe back pain
- Fever with any of the symptoms listed above
- Weight loss
- White-pink mucus
- Tissue that looks like blood clots passing from your vagina
- Fewer signs of pregnancy
If you have these symptoms listed above, contact your doctor right away. They’ll tell you whether to come to the office or go to the emergency room.
Miscarriage Causes and Risk Factors
Most miscarriages happen when the unborn baby has fatal genetic problems. Usually, these problems are not related to the mother.
Other problems that can increase the risk of miscarriage include:
- Medical conditions in the mother, such as diabetes or thyroid disease
- Hormone problems
- Immune system responses
- Physical problems in the mother
- Uterine abnormalities
- Drinking alcohol
- Using street drugs
- Exposure to radiation or toxic substances
A woman has a higher risk of miscarriage if they:
- Are over age 35
- Have certain diseases, such as diabetes or thyroid problems
- Have had three or more miscarriages
Cervical insufficiency. A miscarriage sometimes happens when the mother has a weakness of the cervix. Doctors call this a cervical insufficiency. It means the cervix can’t hold the pregnancy. This type of miscarriage usually happens in the second trimester.
There are usually few symptoms before a miscarriage caused by cervical insufficiency. You may feel sudden pressure, your water might break, and tissue from the baby and placenta could leave your body without much pain. Doctors usually treat an insufficient cervix with a “circling” stitch in the next pregnancy, usually around 12 weeks. The stitch holds your cervix closed until the doctor removes it around the time of delivery. If you never had a miscarriage but your doctor finds that you have cervical insufficiency they might add the stitch to prevent a miscarriage.
There are different kinds of miscarriages, including:
- Threatened miscarriage. You’re bleeding and there’s the threat of a miscarriage, but your cervix hasn’t dilated. Your pregnancy will likely continue without any problems.
- Inevitable miscarriage. You’re bleeding and cramping. Your cervix is dilated. A miscarriage is likely.
- Incomplete miscarriage. Some tissue from the baby or the placenta leaves your body, but some stays in your uterus.
- Complete miscarriage. All the pregnancy tissues leave your body. This type of miscarriage usually happens before the 12th week of pregnancy.
- Missed miscarriage. The embryo dies or was never formed, but the tissues stay in your uterus.
- Recurrent miscarriage (RM). You lose three or more pregnancies in a row during the first trimester. This type of miscarriage only affects about 1% of couples trying to have a baby.
To confirm that you had a miscarriage, your doctor will do:
- A pelvic exam. They’ll check to see if your cervix has started to dilate.
- An ultrasound test. This test uses sound waves to check for a baby’s heartbeat. If the results aren’t clear, you may go back for another test in a week.
- Blood tests. The doctor uses them to look for pregnancy hormones in your blood and compare it to past levels. They may also test you for anemia if you’ve been bleeding a lot.
- Tissue tests. If tissue left your body, the doctor may send it to a lab to confirm that you had a miscarriage. It can also help make sure there wasn’t another cause for your symptoms.
- Chromosome tests. If you’ve had two or more miscarriages, the doctor might do these tests to see if you or your partner’s genes are the cause.
Yes. At least 85% of women who have miscarriages have subsequent normal pregnancies and births. Having a miscarriage does not necessarily mean you have a fertility problem. On the other hand, about 1%-2% of women may have repeated miscarriages (three or more). Some researchers believe this is related to an autoimmune response.
Symptoms & diagnosis
The main symptoms of miscarriage are vaginal bleeding or spotting, with or without abdominal pain or cramping. But sometimes there are no obvious signs at all.
Pain, spotting and bleeding
Bleeding in pregnancy may be light or heavy, dark or bright red. You may pass clots or “stringy bits”. You may have more of a discharge than bleeding. Or you may have spotting, which you notice on your underwear or when you wipe yourself.
Spotting or bleeding may be continuous or it might be on and off, perhaps over days or even weeks. It doesn’t necessarily mean that you are miscarrying or that you will miscarry, but it’s always worth checking.
Pain, like bleeding, can vary. Abdominal pain might be due to a stomach upset or constipation, and backache is common in normal pregnancy, especially as the weeks go by. But if you have bleeding or spotting as well as pain, that might be a sign of miscarriage.
If you have acute, sharp abdominal or one-sided pain or pain in your shoulders, and/or pain on moving your bowels, contact your GP, Early Pregnancy Unit or, if necessary, go to A&E (Casualty). Tell them you are pregnant and describe your symptoms so that they can arrange an emergency scan. That’s especially important if you have previously had an ectopic pregnancy.
Lack or loss of pregnancy symptoms
Lack or loss of pregnancy symptoms can also sometimes be a sign of miscarriage, but like pain and bleeding, that doesn’t necessarily mean there is a problem. Some women have very little in the way of pregnancy symptoms, and many feel differently in different pregnancies.
But if you have strong pregnancy symptoms which suddenly reduce or stop well before 12 weeks of pregnancy, that might mean that hormone levels are dropping. You may want to do another pregnancy test and/or talk to your GP about perhaps having a scan.
In some cases, there are no signs at all that anything is wrong and miscarriage is diagnosed only during a routine scan.
Miscarriage is usually diagnosed or confirmed on an ultrasound scan or scans. The person doing the scan needs to be absolutely certain that the baby (or fetus or embryo) has died or not developed, and they may need more than one scan to confirm that – usually with a gap of at least one week.
Having to wait can be very upsetting but it means that there is no risk of damaging an ongoing pregnancy.
In some cases, especially in later (second trimester) pregnancy, there may be no need for the miscarriage to be confirmed by scan. The physical process of bleeding, pain and passing a recognisable pregnancy sac or delivering a baby, is confirmation in itself. Doctors may still advise a scan in some cases just to ensure that the miscarriage is complete.
In Grant A., 1997, A study of the psychological responses of women immediately after spontaneous and threatened miscarriage Leeds University Hospital, St James’s (Unpublished dissertation), it was noted that about half of the women attending an Early Pregnancy Unit because of bleeding in pregnancy had continuing pregnancies.
For a threatened miscarriage, your health care provider might recommend resting until the bleeding or pain subsides. Bed rest hasn’t been proved to prevent miscarriage, but it’s sometimes prescribed as a safeguard. You might be asked to avoid exercise and sex, too. Although these steps haven’t been proved to reduce the risk of miscarriage, they might improve your comfort.
In some cases, it’s also a good idea to postpone traveling — especially to areas where it would be difficult to receive prompt medical care. Ask your doctor if it would be wise to delay any upcoming trips you’ve planned.
With ultrasound, it’s now much easier to determine whether an embryo has died or was never formed. Either finding means that a miscarriage will definitely occur. In this situation, you might have several choices:
- Expectant management. If you have no signs of infection, you might choose to let the miscarriage progress naturally. Usually this happens within a couple of weeks of determining that the embryo has died. Unfortunately, it might take up to three or four weeks. This can be an emotionally difficult time. If expulsion doesn’t happen on its own, medical or surgical treatment will be needed.
- Medical treatment. If, after a diagnosis of certain pregnancy loss, you’d prefer to speed the process, medication can cause your body to expel the pregnancy tissue and placenta. The medication can be taken by mouth or by insertion in the vagina. Your health care provider might recommend inserting the medication vaginally to increase its effectiveness and minimize side effects such as nausea and diarrhea. For about 70 to 90 percent of women, this treatment works within 24 hours.
- Surgical treatment. Another option is a minor surgical procedure called suction dilation and curettage (D&C). During this procedure, your health care provider dilates your cervix and removes tissue from the inside of your uterus. Complications are rare, but they might include damage to the connective tissue of your cervix or the uterine wall. Surgical treatment is needed if you have a miscarriage accompanied by heavy bleeding or signs of an infection.
In most cases, physical recovery from miscarriage takes only a few hours to a couple of days. In the meantime, call your health care provider if you experience heavy bleeding, fever or abdominal pain.
You may ovulate as soon as two weeks after a miscarriage. Expect your period to return within four to six weeks. You can start using any type of contraception immediately after a miscarriage. However, avoid having sex or putting anything in your vagina — such as a tampon — for two weeks after a miscarriage
- It’s possible to become pregnant during the menstrual cycle immediately after a miscarriage. But if you and your partner decide to attempt another pregnancy, make sure you’re physically and emotionally ready. Ask your health care provider for guidance about when you might try to conceive.
- Keep in mind that miscarriage is usually a one-time occurrence. Most women who miscarry go on to have a healthy pregnancy after miscarriage. Less than 5 percent of women have two consecutive miscarriages, and only 1 percent have three or more consecutive miscarriages.
- If you experience multiple miscarriages, generally two or three in a row, consider testing to identify any underlying causes — such as uterine abnormalities, coagulation problems or chromosomal abnormalities. If the cause of your miscarriages can’t be identified, don’t lose hope. About 60 to 80 percent of women with unexplained repeated miscarriages go on to have healthy pregnancies.