Everything You Need to Know About Miscarriage
Medically reviewed by Rachel Liberto, RN on August 13, 2019
Miscarriages are discussed so infrequently, or in such hushed and secretive terms, that many people—even women who have experienced a miscarriage—mistakenly believe the event is rare. The truth is, around 30% of pregnancies end with miscarriage.
What is a miscarriage?
Miscarriage is a spontaneous (as opposed to medically induced) abortion occurring before the 20th week of pregnancy.
What are the first signs of a miscarriage?
Miscarriage signs and symptoms can vary, and it’s important to remember that many of these symptoms can also occur in a perfectly healthy pregnancy. The two biggest symptoms that could indicate a miscarriage are vaginal bleeding and cramping. Keep in mind that spotting during pregnancy can be perfectly benign. 10–15% of women experience early pregnancy bleeding, and nearly all women with bleeding go on to have successful pregnancies. Cramping could be caused by gas or your expanding uterus. When cramping and bleeding happen simultaneously, it’s a good idea to talk to your doctor. Other potential indicators of miscarriage can include:
- Painful true contractions
- Backache or back pain
- Passing clots or other tissue from the vagina
- A whitish-pink mucous discharge
- A sudden loss of pregnancy symptoms or a feeling of no longer being pregnant (though remember, these symptoms fluctuate a lot in completely healthy pregnancies, and differ from person to person)
What causes miscarriage?
Most miscarriages result from chromosomal and genetic abnormalities or other health factors beyond our control. Chromosomes hold genes, and in a viable pregnancy, one set of chromosomes is provided by each parent. Abnormalities generally occur when an egg or sperm cell are damaged or when the fertilized egg has difficulties during the division process. Placental problems can also result in miscarriage.
Maternal age, health, lifestyle choices, and trauma can affect the likelihood of a pregnancy ending in miscarriage.
How can you prevent a miscarriage?
First and foremost, you can’t do anything to stop or prevent miscarriages caused by chromosomal abnormalities. These miscarriages can happen to anyone, and they account for the highest number of pregnancy losses.
It’s important to get as healthy as you can before conceiving. This means eating well, exercising regularly, managing your stress, and trying to keep your weight within healthy limits. Take a folic acid supplement daily. Adequate folic acid can prevent serious birth defects that typically form before you even know you’re pregnant.
Drug and alcohol use, smoking or being around smoke, and drinking excessive caffeine (more than 200 mg daily i.e two cups of coffee or five cans of caffeinated soda) can increase the risk of miscarriage, birth defects, and poor pregnancy outcomes. Check with your doctor before taking over-the-counter medications. Once you’re pregnant, avoid contact sports, activities with a risk of injury, and environmental hazards like radiation and infectious diseases.
Underlying health conditions like malnutrition, obesity, or being underweight; high blood pressure; uncontrolled or untreated thyroid disease or diabetes; or hormonal issues can lead to problems conceiving or carrying a pregnancy to term. Certain medications, problems with the cervix, or an abnormally shaped uterus should all be discussed with your doctor if you’re thinking of trying to get pregnant .
Now for the good news: Sex doesn’t cause miscarriages, and neither does working—unless you work in a hazardous environment where you’re exposed to radiation or chemicals, or where you’re at increased risk for getting physically hurt. Moderate exercise doesn’t cause miscarriages either. In most cases, continuing to exercise throughout pregnancy is recommended, as it can lead to better health outcomes for both mother and child.
What are the different types of miscarriage?
As devastating as it can feel, neither you nor your doctor can stop a miscarriage that’s already in process. Doctors can only monitor your condition and health to ensure the miscarriage doesn’t lead to further complications.
- In a complete miscarriage, all pregnancy tissues are expelled from your body.
- In a partial or incomplete miscarriage, some tissue or placental material is passed, but the rest remains in your body.
- In a missed miscarriage, the embryo dies without your knowledge. You don’t find out you’ve lost the pregnancy until your next doctor’s appointment. Fortunately, this kind of miscarriage is rare, occurring in only about 3% of all known pregnancies.
- In a threatened miscarriage, you have bleeding and cramps pointing to a possible miscarriage. It’s important to note that not all threatened miscarriages will end in a loss of pregnancy. You may be advised to rest, avoid sexual intercourse, and monitor your symptoms. Many women who experience threatened miscarriages go on to have normal pregnancies.
- In an inevitable miscarriage, bleeding, cramping, and cervical dilation indicate a miscarriage is unavoidable.
- A septic miscarriage can be a miscarriage caused by an infection in the uterus (for example, an untreated sexually transmitted infection causing pelvic inflammatory disease). It can also be caused by an incomplete miscarriage where the tissues from the pregnancy are not all expelled from the uterus, causing an infection in the uterus. This is why it is important to be seen by your heath care provider if you believe yourself to have had or are having a miscarriage. Your healthcare provider can confirm the type of miscarriage and ensure that the uterus has not retained any tissues of the pregnancy. Contact your healthcare provider if you experience any signs and symptoms of infection such as fever, foul smelling vaginal bleeding or discharge, abdominal pain/tenderness, or heavy bleeding (soaking through one pad per hour for two hours).
Types of non-viable pregnancies that result in miscarriage or require medical intervention include blighted ovum, molar pregnancy, and ectopic pregnancy.
- A blighted ovum occurs when no embryo forms. Basically, this means that although a sperm fertilized an egg, the necessary genetic material wasn’t present. Unfortunately, your body doesn’t always get the message and continues producing the pregnancy hormones that will show up as a positive pregnancy test.
- A molar pregnancy happens when there’s a placental cell defect that causes cells to grow too fast—much faster than the embryo. Molar pregnancies are particularly dangerous because the cells can sometimes travel to different parts of your body and turn cancerous. If you experience a molar pregnancy, your doctor will monitor you closely. It’s likely you’ll be advised to wait 6–12 months before trying to get pregnant again.
- An ectopic pregnancy happens when an egg implants in tissue outside the uterus. This kind of pregnancy is not viable and must be treated immediately. Though some ectopic pregnancies miscarry on their own, many require surgical intervention to prevent the fallopian tubes from bursting—which is a credible threat to the mother’s life.
Do you have to go to the hospital after a miscarriage?
An early miscarriage isn’t necessarily a medical emergency. If you experience bleeding within a day or two of a positive pregnancy test, you may have experienced a chemical pregnancy, where the body produced just enough pregnancy hormone to register positively on a test, but the pregnancy was never viable. Taking a second pregnancy test a day or two after the bleeding starts will likely result in a negative.
Rather than heading to the hospital immediately, if you suspect you’re having a miscarriage, you should call your doctor. It’s likely you’ll be asked to come in for an office visit. Your medical practitioner will have access to your medical records and will use diagnostic tests to determine if you’re having a miscarriage.
If you experience severe bleeding (soaking through a menstrual pad every hour); fever or chills; severe abdominal pain or cramping, especially if it occurs on either side of the lower abdomen; dizziness; or symptoms of shock, like confusion, agitation, or bluish lips and nails, you should seek emergency care.
How do you manage a miscarriage?
If you’ve had a complete miscarriage and no tissue remains in your body, no further treatment is necessary. When tissue remains, you have a few treatment options.
- Expectant management involves waiting for the remaining tissue to pass naturally out of your body.
- Medical management involves taking medications to help you pass the rest of the remaining tissue
- Surgical management involves surgically removing any remaining tissue. This is called a dilation and curettage (or D&C). If all the tissue isn’t expelled using the first two options, which is a possibility, a D&C will be necessary.
For many women, a miscarriage is a difficult and emotional event made even more challenging by the widespread idea that you shouldn’t announce your pregnancy before the end of your first trimester. Unfortunately, if no one knows you were pregnant, and no one knows you had a miscarriage, there’s no one to talk to or lean on.
What week has the highest risk of miscarriage?
Miscarriage risk is highest in the first trimester, or the first 13 weeks of your pregnancy. For most women, the chance of having a miscarriage after 14 weeks is less than 1%.
A chemical pregnancy is a very early miscarriage that happens before the fifth week of gestation—or within about one week of your expected period. A clinical pregnancy is any pregnancy that survives until the sixth week.
In pregnancies with a confirmed fetal heartbeat, miscarriage rates decline between 6–10 weeks. Remember, pregnancies are calculated from the first day of your last period, meaning that week six of pregnancy is equal to approximately two weeks after your missed period.
|WEEK||RISK OF MISCARRIAGE (%)|
The chances of miscarrying increase for women over 35
According to a study of 384 women 35 and older, by 12 weeks, women 35–37 are 2.8% likely to miscarry, women 37–39 are 7.5% likely to miscarry, and women over 40 are 10.8% likely to miscarry. By age 45, a woman’s miscarriage risk is almost 100%.
How soon can you get pregnant after a miscarriage?
Having a miscarriage does not mean you will have difficulty getting pregnant or carrying a baby to term. In fact, getting pregnant after miscarriage might even be easier if you try right away.
While evidence indicates the function of your ovaries might not be entirely back to normal in the first cycle following a miscarriage, most women rapidly return to ovulation. Contrary to the conventional wisdom that cautions a wait of 3–6 months after early loss before trying to conceive again, a large-scale study found significant evidence that couples who conceived within three months of a pregnancy loss were more likely to achieve a pregnancy leading to a live birth than those who waited three months or more to try again.
After an early loss, it’s natural to feel apprehensive about trying again. Repeated miscarriages are relatively rare; only 1% of women will have more than one. If you experience multiple miscarriages, it may be due to an underlying condition, and you should consult your healthcare provider.
As soon as you’ve stopped bleeding, you can start having sex again. Tracking your fertility using Ava or other methods can help you pinpoint the days where sex is most likely to result in conception.
What is a rainbow baby? Like the hopeful rainbow after a storm, a healthy baby born after a miscarriage or stillbirth is often called a rainbow baby. The majority of women who experience a miscarriage will go on to conceive a rainbow baby.
Questions & Answers
How do you know when a miscarriage starts?
Often, a miscarriage is a process, not a single event. Diagnosis may take up to a week since repeated tests are required for confirmation. Unless you’re experiencing severe bleeding, cramping, or other symptoms of an emergency, it’s best to call your doctor and talk about your concerns and your options.
Am I having a miscarriage or a period?
Many women have early miscarriages and never know they were pregnant. In general, bleeding and cramping is more severe with a miscarriage—though even this isn’t a sure symptom. Typically, the symptoms of a miscarriage get worse and last longer than a period.
Can you take a pregnancy test to see if you miscarried?
Pregnancy tests measure a pregnancy hormone called human chorionic gonadotropin (hCG). This hormone is produced by the placenta only after implantation. If a negative pregnancy test follows a positive one, it’s possible you miscarried or are in the process of miscarrying. However, a pregnancy test is not used to detect miscarriage, and cannot detect other serious complications like an ectopic or molar pregnancy.
Can you miscarry without knowing?
Many women miscarry without knowing they conceived. These chemical pregnancies are easily mistaken for periods since the miscarriage happens around the same time a period was expected.
Unfortunately, some women have missed or silent miscarriages. These miscarriages have no symptoms, and the lost pregnancy is only discovered at the next prenatal visit, when scans reveal that embryonic death has occurred.
How can you confirm a miscarriage at home?
Only a doctor can confirm a miscarriage. A physician will use diagnostic tests, such as a pelvic exam, ultrasound, blood tests, tissue tests, and chromosomal tests to confirm that a miscarriage is occurring or has already occurred.