What Is a 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 these symptoms
- Weight loss
- White-pink mucus
- Tissue that looks like blood clots passing from your vagina
- Fewer signs of pregnancy
If you have these symptoms, 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 check whether you've 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.
If the miscarriage is complete and your uterus is empty, you probably won’t need further treatment.
Sometimes all the tissue doesn’t come out. If that happens, your doctor might do a dilation and curettage (D&C) procedure. They’ll dilate your cervix and gently remove any remaining tissue. There are also medications you can take that cause any tissue left in your uterus to leave your body. This may be a better option if you want to avoid surgery.
If it’s later in the pregnancy and the fetus has died in the womb, the doctor will induce labor and delivery.
When the bleeding stops, you should be able to go back to your normal activities. If your cervix dilated on its own but you’re still pregnant, you could have a condition known as incompetent cervix. Your doctor might do a procedure to close it called cerclage.
If your blood type is Rh negative, the doctor may give you a blood product called Rh immune globulin (Rhogam). This prevents you from developing antibodies that could harm your baby or any future pregnancies.
You may get blood tests, genetic tests, or medication if you’ve had more than two miscarriages in a row (recurrent miscarriage). To diagnose this condition, your doctor might use tests like:
- Pelvic ultrasound
- Hysterosalpingogram, An X-ray of the uterus and fallopian tubes
- Hysteroscopy. The doctor uses a thin, telescope-like device inserted through your vagina and cervix to look inside your uterus
If you've had two miscarriages in a row, use a form of birth control and talk to your doctor about tests to find the cause
Symptoms Following a Miscarriage
Bleeding and mild discomfort are common symptoms after a miscarriage. If you have heavy bleeding with fever, chills, or pain, contact your doctor right away. These may be signs of an infection.
Besides the physical effects, you may also feel a range of emotions, from sadness and guilt to grief and worry about future pregnancies. What you’re feeling is normal. Let yourself grieve.
If you’re up to it, talk to people in your life who are supportive like your partner, a friend, or family member. You can also talk to a professional mental health counselor. Pregnancy loss support groups may also be a valuable resource to you and your partner. Ask your doctor for more information about these resources. And remember that everyone heals at a different pace and in different ways.
Pregnancy Following a Miscarriage
You can get pregnant after a miscarriage. At least 85% of women who have one go on to have normal pregnancies and births. Having a miscarriage doesn’t 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.
If you've had two miscarriages in a row, you should stop trying to conceive, use a form of birth control, and ask your doctor to do tests to figure out what’s causing the miscarriages.
When to Try to Conceive After a Miscarriage
Discuss the timing of your next pregnancy with your doctor. Some experts say you should wait a certain amount of time (from one menstrual cycle to 3 months) before you try again. While this is not a widespread practice, to prevent another miscarriage the doctor may suggest treatment with progesterone, a hormone that helps the embryo implant and supports early pregnancy in your uterus.
Taking time to heal both physically and emotionally after a miscarriage is important. Above all, don't blame yourself. Counseling is available to help you handle your loss.
Most miscarriages happen because there’s a problem with the pregnancy. You can’t prevent them. If your doctor does testing and finds a problem, treatment options may be available.
If you have an illness, treating it can improve your chances for a successful pregnancy. One step you can take is to get as healthy as you can before you try to have a baby:
- Get regular exercise.
- Eat a healthy, well-balanced diet.
- Maintain a healthy weight.
- Avoid infections.
- Don’t smoke, drink alcohol, or take illegal drugs.
- Cut back on caffeine.