What is a miscarriage?
A miscarriage, or spontaneous abortion, is an event that results in the loss of a fetus before 20 weeks of pregnancy. It typically happens during the first trimester, or first three months, of the pregnancy.
Miscarriages can happen for a variety of medical reasons, many of which aren’t within a person’s control. But knowing the risk factors, signs, and causes can help you to better understand the event and get any support or treatment you may need.
While there are some things that increase the risk of miscarriage, generally it isn’t a result of something that you did or didn’t do. If you’re having difficulty maintaining pregnancy, your doctor may check for some known causes of miscarriage.
During pregnancy, your body supplies hormones and nutrients to your developing fetus. This helps your fetus grow. Most first trimester miscarriages happen because the fetus doesn’t develop normally. There are different factors that can cause this.
Genetic or chromosome issues
Chromosomes hold genes. In a developing fetus, one set of chromosomes is contributed by the mother and another by the father.
Examples of these chromosome abnormalities include:
- Intrauterine fetal demise: The embryo forms but stops developing before you see or feel symptoms of pregnancy loss.
- Blighted ovum: No embryo forms at all.
- Molar pregnancy: Both sets of chromosomes come from the father, no fetal development occurs.
- Partial molar pregnancy: The mother’s chromosomes remain, but the father has also provided two sets of chromosomes.
Errors can also occur randomly when the cells of the embryo divide, or due to a damaged egg or sperm cell. Problems with the placenta can also lead to a miscarriage.
Underlying conditions and lifestyle habits
Various underlying health conditions and lifestyle habits may also interfere with the development of a fetus. Exercise and sexual intercourse do not cause miscarriages. Working won’t affect the fetus either, unless you’re exposed to harmful chemicals or radiation.
Conditions that can interfere with fetus development include:
- poor diet, or malnutrition
- drug and alcohol use
- advanced maternal age
- untreated thyroid disease
- issues with hormones
- uncontrolled diabetes
- problems with the cervix
- abnormally shaped uterus
- severe high blood pressure
- food poisoning
- certain medications
Always check with your doctor before taking any medications to be sure a drug is safe to use during pregnancy.
Miscarriage Signs and Symptoms
The symptoms of a miscarriage vary, depending on your stage of pregnancy. In some cases, it happens so quickly that you may not even know you’re pregnant before you miscarry.
Here are some of the symptoms of a miscarriage:
- heavy spotting
- vaginal bleeding
- discharge of tissue or fluid from your vagina
- severe abdominal pain or cramping
- mild to severe back pain
Call your doctor right away if you experience any of these symptoms during your pregnancy. It’s also possible to have these symptoms without experiencing a miscarriage. But your doctor will want to conduct tests to make sure that everything is fine.
Miscarriage or period?
Many times, a miscarriage can happen before you even know that you’re pregnant. Additionally, as with your menstrual period, some of the symptoms of a miscarriage involve bleeding and cramping.
So how can you tell if you’re having a period or a miscarriage?
When trying to distinguish between a period and a miscarriage, there are several factors to consider:
- Symptoms: Severe or worsening back or abdominal pain, as well as passing fluids and large clots, could indicate a miscarriage.
- Time: A miscarriage very early in pregnancy can be mistaken for a period. However, this is less likely after eight weeks into a pregnancy.
- Duration of symptoms: The symptoms of a miscarriage typically get worse and last longer than a period.
If you’re experiencing heavy bleeding or believe that you’re having a miscarriage, you should contact your doctor.
Miscarriage rate by week
Most miscarriages happen within the first trimester (first 12 weeks) of pregnancy. The earliest weeks of pregnancy are when a woman is at the highest risk of a miscarriage. However, once a pregnancy reaches 6 weeks, this risk drops.
From weeks 13 to 20 of pregnancy, the risk of miscarriage drops further. However, it’s important to keep in mind that miscarriage risk doesn’t change much after this, as complications can arise at any point in a pregnancy.
The early loss of a pregnancy is common. According to the American College of Obstetricians and Gynecologists (ACOG), it occurs in 10 percent of known pregnancies.
Sometimes the cause of a miscarriage will remain unknown. However, the Mayo Clinic estimates that about 50 percent of miscarriages are due to chromosome issues.
The risk of miscarriage definitely increases with age. According to the Mayo Clinic, the risk of miscarriage is 20 percent at age 35. It increased to 40 percent at age 40 and rises further to 80 percent at age 45.
A miscarriage doesn’t mean that you won’t go on to have a baby. According to the Cleveland Clinic, 87 percent of women who have had a miscarriage will go on to carry a baby to full term. Approximately only 1 percent of women have three or more miscarriages.
Most miscarriages are due to natural and unpreventable causes. However, certain risk factors can increase your chances of having a miscarriage. These include:
- body trauma
- exposure to harmful chemicals or radiation
- drug use
- alcohol abuse
- excessive caffeine consumption
- two or more consecutive miscarriages
- being underweight or overweight
- chronic, uncontrolled conditions, like diabetes
- problems with the uterus or cervix
Being older can also affect your risk of miscarriage. Women who are over 35 years old have a higher risk of miscarriage than women who are younger. This risk only increases in the following years.
Having one miscarriage doesn’t increase your risk of having other miscarriages. In fact, most women will go on to carry a baby full term. Repeated miscarriages are actually quite rare.
There are many different types of miscarriage. Depending on your symptoms and the stage of your pregnancy, your doctor will diagnose your condition as one of the following:
- Complete miscarriage: All pregnancy tissues have been expelled from your body.
- Incomplete miscarriage: You’ve passed some tissue or placental material, but some still remain in your body.
- Missed miscarriage: The embryo dies without your knowledge, and you don’t deliver it.
- Threatened miscarriage: Bleeding and cramps point to a possible upcoming miscarriage.
- Inevitable miscarriage: The presence of bleeding, cramping, and cervical dilation indicates that a miscarriage is inevitable.
- Septic miscarriage: An infection has occurred within your uterus.
Not all miscarriages can be prevented. However, you can take steps to help maintain a healthy pregnancy. Here are a few recommendations:
- Get regular prenatal care throughout your pregnancy.
- Avoid alcohol, drugs, and smoking while pregnant.
- Maintain a healthy weight before and during pregnancy.
- Avoid infections. Wash your hands thoroughly, and stay away from people who are already sick.
- Limit the amount of caffeine to no more than 200 milligrams per day.
- Take prenatal vitamins to help ensure that you and your developing fetus get enough nutrients.
- Eat a healthy, well-balanced diet with lots of fruits and vegetables.
Remember that having a miscarriage doesn’t mean you won’t conceive again in the future. Most women who miscarry have healthy pregnancies later.
Miscarriage with twins
Twins typically happen when two eggs are fertilized instead of one. They can also happen when one fertilized egg splits into two separate embryos.
Naturally, there are additional considerations when a woman is pregnant with twins. Having multiple babies in the womb can affect growth and development. Women who are pregnant with twins or other multiples may be more likely to have complications such as preterm birth, preeclampsia, or miscarriage.
Additionally, a type of miscarriage called vanishing twin syndrome can affect some who are pregnant with twins. Vanishing twin syndrome occurs when only one fetus can be detected in a woman who was previously determined to be pregnant with twins.
In many cases, the vanished twin is reabsorbed into the placenta. Sometimes this happens so early in the pregnancy that you didn’t even know you were pregnant with twins.
The treatment that you receive for a miscarriage can depend on the type of miscarriage that you’ve had. If there’s no pregnancy tissue left in your body (complete miscarriage), no treatment is required.
If there’s still some tissue present in your body, there are a few different treatment options:
- expectant management, which is where you wait for the remaining tissue to pass naturally out of your body
- medical management, which involves taking medications to help you pass the rest of the remaining tissue
- surgical management, which involves having any remaining tissue surgically removed
The risk of complications from any of these treatment options is very small, so you can work with your doctor to determine which one is best for you.
Your body’s recovery will depend on how far along your pregnancy was before the miscarriage. After a miscarriage, you might experience symptoms such as spotting and abdominal discomfort.
While pregnancy hormones might last in the blood for a couple of months after a miscarriage, you should start having normal periods again in four to six weeks. Avoid having sex or using tampons for at least two weeks after having a miscarriage.
Support after a miscarriage
It’s normal to experience a wide range of emotions after a miscarriage. You may also experience symptoms such as trouble sleeping, low energy, and frequent crying.
Take your time to grieve for your loss, and ask for support when you need it. You may also want to consider the following:
- Reach out for help if you’re overwhelmed. Your family and friends may not understand how you’re feeling, so let them know how they can help.
- Store any baby memorabilia, maternity clothing, and baby items until you’re ready to see them again.
- Engage in a symbolic gesture that may help with remembrance. Some women plant a tree or wear a special piece of jewelry.
- Seek counseling from a therapist. Grief counselors can help you cope with feelings of depression, loss, or guilt.
- Join an in-person or online support group to talk with others who have been through the same situation.
Getting pregnant again
Following a miscarriage, it’s a good idea to wait until you’re both physically and emotionally ready before trying to conceive again. You may want to ask your doctor for guidance or to help you develop a conception plan before you try to get pregnant again.
A miscarriage is typically only a one-time occurrence. However, if you’ve had two or more consecutive miscarriages, your doctor will recommend testing to detect what may have caused your previous miscarriages. These may include:
- blood tests to detect hormone imbalances
- chromosome tests, using blood or tissue samples
- pelvic and uterine exams
Frequently Asked Questions about Miscarriage
I’m bleeding/spotting. Am I miscarrying?
You might be, but even heavy bleeding doesn’t always mean miscarriage. An ultrasound might tell you more, but not till about 7 weeks and even then, it might not give a full picture.
Consider contacting your GP, midwife, Early Pregnancy Unit or Accident & Emergency department if you have more pain and bleeding than you can cope with.
Do contact your GP, midwife, Early Pregnancy Unit or Accident & Emergency department if you:
- Have previously had an ectopic pregnancy, or
- Have sharp one-sided pain and/or pain in your shoulders, or
- Feel very faint or dizzy.
Early diagnosis and treatment of ectopic pregnancy won’t save the pregnancy but may prevent an acute emergency and can mean less radical treatment.
When can I have a scan? / Why do I have to wait for a scan? / Why do I have to have a repeat scan?
The best time to have a scan is from about 7 weeks’ gestation when it should be possible to see the baby’s heartbeat. But it can be hard to detect a heartbeat in early pregnancy and it can be hard to know whether the baby has died or not developed at all, or whether it is simply smaller than expected but still developing.
What’s a fetal pole?
The fetal pole is the first visible sign of a developing embryo, with the embryo’s head at one end and what looks like a tail at the other end. If you read or hear the term ‘crown-rump length, or CRL, that describes the measurement from head to ‘tail’, which helps to date a pregnancy.
What’s a missed miscarriage? Why does it happen?
A missed miscarriage (also called silent or delayed miscarriage) is where the baby has died or failed to develop but your body has not actually miscarried him or her. The scanned picture shows a pregnancy sac with a baby (or fetus or embryo) inside, but there is no heartbeat and the pregnancy looks smaller than it should be at this stage. Pregnancy hormone levels may still be high, so you may have had no idea that anything was wrong, still, feel pregnant and have a positive pregnancy test.
It’s not clear if there is a particular reason for this kind of miscarriage. Some people think it’s just the downside of early pregnancy tests and ultrasound: if the miscarriage wasn’t diagnosed on, say, a booking scan, you would only know you had miscarried when that physical process started.
What are the options for treating a missed or incomplete miscarriage?
The options are natural (waiting for nature to take its course), medical (tablets or pessaries to start or speed up the miscarriage process) or surgical (removing the remains of your pregnancy, under general or local anesthetic).
Can I choose how my miscarriage is ‘managed’?
You should usually be able to choose the option you feel you can cope with best, but there may be medical reasons that you shouldn’t have one or another option, or it may be that the hospital doesn’t offer all kinds of management.
National (NICE) guidance also advises hospitals to suggest natural management for two weeks or so in many cases, before offering other options. If you really don’t want this and there’s no medical reason for waiting, you may need to push for having medical or surgical management – but it’s not a right.
What happens to the remains of my baby?
New guidance advises that hospitals should offer the option of arranging cremation or burial of pregnancy remains or, if parents prefer, the option of taking the baby’s remains home and making private arrangements. You should be given time to decide. However, actual practice varies a great deal and sadly, some hospitals may still treat the remains of an early loss as clinical waste unless you request otherwise. (This is not illegal in England and Wales, although Scottish guidance is different.)
What happens in hospital?
It depends on your symptoms, which department you’re seen in and what day and time it is.
If you are seen in Accident & Emergency (A&E, Casualty), you may have to wait a long time, especially if it’s busy. You may not be seen as a priority and others might be seen ahead of you. If you’re bleeding heavily, you might feel embarrassed.
After you are seen you may be referred to an Early Pregnancy Unit (EPU) or a gynecology ward, either straight away or at another date. Most EPUs are open only limited hours and very few in evenings or weekends.
If you are seen at a specialist EPU or emergency gynecology unit, you will be seen by people who understand pregnancy loss. They’ll advise what happens next. There will still be some waiting, perhaps with some people who are upset and anxious and others who are excited and/or visibly pregnant.
What is a chemical pregnancy?
Chemical pregnancy (sometimes called biochemical pregnancy) is a term that doctors sometimes use to describe a very early pregnancy loss. This kind of loss usually happens just after the embryo implants (before or around 5 weeks) and before anything can be seen on an ultrasound scan.
There is usually no need for medical treatment or intervention.
However early the loss, it can still be distressing.
When can we have sex again? When can we try again?
It’s best to avoid having sex until any bleeding has stopped, to reduce the risk of infection. Once bleeding has stopped, you can try again whenever you and your partner feel ready – although the advice on timing might be different after a late miscarriage, ectopic or molar pregnancy.
If you wait until after your first period it can make it easier to date another pregnancy, but it won’t make any difference to the risk of miscarrying again.
When will I get my period?
In most cases, between 4 and six weeks after your loss, though this can vary. That first period may be heavier and last longer than usual.
If you haven’t had a period after 6 weeks, it’s worth doing a pregnancy test. If it’s positive, but you know there’s no chance you could be pregnant again, it is a good idea to contact your GP or the hospital where you were treated.
Why did I have a miscarriage/ectopic pregnancy/molar pregnancy? Was it something I did?
It’s usually difficult to know why any pregnancy loss happens, though it’s highly unlikely to be because of anything you did or didn’t do.
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