What Is Miscarriage?

A miscarriage – sometimes referred to as a spontaneous abortion or early pregnancy loss – is the term used to describe a loss of pregnancy that occurs before the 20^th week. But the majority of miscarriages happen during the first trimester (up to the 13^th week of pregnancy). Miscarriage is common; it occurs in an estimated 10 to 20 percent of pregnancies. The good news is that most women who experience a miscarriage are able to eventually have a successful pregnancy.

Signs and Symptoms

Signs and symptoms for miscarriage can be different for each individual. Miscarriages tend to happen before 12 weeks.

Common signs and symptoms include:

• Vaginal spotting (for 3 days or more) or heavy bleeding
• Abdominal pain or cramping, pain in your lower back
• Tissue or fluid passing from your vagina
• Disappearance of pregnancy symptoms, such as feeling nauseated and breast tenderness

Risk Factors

Risk factors increase a person’s chance at developing a specific condition or disease. Risk factors for miscarriage include:

• Age. Research shows that the rate of miscarriage of women in their 20’s is 12-15% and it rises to about 25% by age 40. The increased rate of chromosomal abnormalities has a strong correlation to age-related miscarriages.
• Previous miscarriage. Women who have had two or more consecutive miscarriages are at a greater risk.
• Chronic conditions. Women who have chronic conditions such as uncontrolled diabetes, disorders of the immune system, thyroid disease, congenital heart disease, or severe kidney disease can all increase risk.
• Smoking, alcohol, illegal drug use. Smoking, heavy alcohol consumption, or use of illegal drugs contribute to a greater risk of miscarriage.
• Weight. Malnutrition (or being severely underweight) as well as obesity (severely overweight) contribute to an increased risk of miscarriage.
• Uterine or cervical problems. Certain uterine abnormalities or weakened cervical tissue may increase risk.
• Certain environmental or workplace toxins or hazards. Exposure to environmental toxins, such as radiation, may contribute to an increased risk of miscarriage.

Causes

Many women fear they have done something to cause their miscarriage, but that is very unlikely. Activities such as moderate exercise and sexual intercourse do not cause miscarriage. The majority of miscarriages – especially those that occur during the first trimester – are caused by chromosomal abnormalities. When an embryo has extra or missing chromosomes it cannot develop normally, which often results in miscarriage. Less frequent causes of loss of a pregnancy may include:

• Infection
• Maternal health problems (such as uncontrolled diabetes)
• Hormonal problems
• Exposure to toxic chemicals or radiation
• Uterine abnormalities that affect implantation of the embryo
• Weak cervical tissue

Types of Pregnancy Loss

There are many different types of miscarriages and most are a result of the fetus not developing appropriately. It is important to note that 87% of women who have miscarriages go on to have normal pregnancies and deliveries. The miscarriage types are distinguished by when they occur and why they occur. The most common types of miscarriages include:

• Chemical pregnancy. This type of miscarriage is referred to as a chemical pregnancy because although the pregnancy hormone (hCG) increases, which can result in a positive pregnancy test, the fertilized egg never implants in the uterus. An ultrasound would reveal no placenta or gestational sac. Without a pregnancy test, these types of miscarriages often go unnoticed because they happen so early on in pregnancy.
• Blighted ovum. This happens when the egg is fertilized and starts to attach to the uterus, but no embryo develops.
• Threatened miscarriage. A healthcare provider may determine that there is high risk for a miscarriage up until 20 weeks, specifically if there has been heavy bleeding. However, a “threatened miscarriage” does not mean that a miscarriage has or will occur. Often, you can still hear the baby’s heartbeat in the ultrasound and more than half of the women with a threatened miscarriage carry the baby full term and have a healthy and safe delivery.
• Inevitable miscarriage. This is diagnosed when there is heavy bleeding and a doctor determines that the cervix is open, and the body has already begun the natural process of releasing tissue from the pregnancy. It cannot be stopped or reversed. 
• Missed miscarriage. On some occasions, a woman will not experience any bleeding during a miscarriage. The miscarriage won’t be discovered until the next prenatal appointment, when no fetal heartbeat is detected.

Treatment

If you suspect you are having or have had a miscarriage, seek out medical care immediately. A healthcare provider will perform a physical exam and ultrasound to check for a fetal heartbeat and see whether or not the embryo is still growing in your uterus. If miscarriage is suspected, your doctor may follow up with a blood test to see if levels of the pregnancy hormone, hCG, are decreasing. In many cases, no medical treatment is necessary after experiencing a miscarriage. But if an ultrasound reveals the pregnancy has not been fully expelled from your uterus, your doctor may recommend any of the following miscarriage treatments:

• Expectant management: In most cases, the fetal tissue will pass naturally within two weeks with heavy bleeding. Your doctor will monitor your condition to make sure this happens.
• Medication: Medication – taken orally or inserted into the vagina – can be used to help your body pass the fetal tissue more quickly, usually within 24 hours.
• Surgery: If you develop an infection, your doctor may recommend a dilation and curettage (D&C) procedure. This is done under general anesthesia and allows your doctor to remove all of the fetal tissue.

Support after a Miscarriage

Experiencing a miscarriage can be devastating. Whether it is your first miscarriage or you’ve had multiple miscarriages, your grief and loss were not meant to be felt in isolation. Every woman’s experience is unique, and is often times accompanied by a wide range of emotions such as grief, depression, anxiety, shame, anger, or confusion. It is important to remember that you are not alone in your suffering, and there are many resources to help grieving mothers. A few resources and recommendations include:

• Seek professional mental health counseling. Mental health is equally important as physical health, and it is critical to our overall wellbeing to be proactive and connect with available resources. You may want to look for someone specifically trained in grief counseling.
• Reach out to trusted friends and family members who may not understand the full extent of your loss, and utilize them for support during this difficult time.
• Find support groups (in-person or virtual) specifically for miscarriages or grief and loss.
• Engage in a symbolic gesture, such as planting a tree in remembrance, wearing a specific piece of jewelry, or having a piece of artwork that is representative of the loss.
• Consider if you need to put away baby items or memorabilia until you are ready to see them again.

Getting pregnant again after a miscarriage depends on different factors. It is important to allow yourself time to work through necessary emotional and physical healing before trying to conceive again. If you are planning to get pregnant again, it is recommended to speak with your doctor for guidance. Additionally, consult your doctor for further testing if the miscarriage was the second consecutive one, in order to determine the cause and steps moving forward.

Will a Miscarriage Affect Future Pregnancies?

Most miscarriages are a one-time event. The majority of women who have a miscarriage go on to eventually have a successful pregnancy and birth. But any pregnancy loss, even very early on, can be emotionally difficult. Be sure you and partner get the support you need before trying to become pregnant again.

Only about 1 percent of women experience three or more miscarriages. If you do have recurrent pregnancy losses, you may consider testing – such as chromosomal screening or tests that look for uterine abnormalities – to determine if there is an underlying cause that could be addressed.