What is a miscarriage?

When a pregnancy ends on its own at some point during the first twenty weeks of gestation, it is referred to as a miscarriage. Research has shown that up to 25% of pregnancies end in miscarriage and that the majority of miscarriages occur within the first 13 weeks of pregnancy, also known as the first trimester

When a miscarriage occurs shortly after implantation, a woman may not have realized that she was pregnant yet, and may mistake the bleeding for expected menstruation. Pregnancies that end after week 20 are typically referred to as a stillbirth

Signs and symptoms of miscarriage

If you believe that you might be having a miscarriage, contact your health care provider. 

Bleeding

Bleeding is one of the most common signs of miscarriage. The amount of bleeding experienced during a miscarriage can differ, but generally, the heaviest bleeding lasts for a few hours followed by lighter bleeding that may continue for several days. It is recommended to call a doctor if more than two sanitary pads are needed within one hour. 

It is important to note that not all pregnancies that involve bleeding will result in miscarriage.

Discharge

In addition to blood, when a miscarriage is occurring there may be other discharge from the vagina, including a pinkish white mucous or blood clots and soft tissue. 

Contractions

Cramping in the lower back, abdomen, or pelvic area occurring every five to twenty minutes may mean that the uterus is contracting and could be a sign of miscarriage. 

Other common symptoms of miscarriage could include

Types of miscarriage

Complete miscarriage

When the body naturally expels the fetus and all of the pregnancy tissue and the cervix closes before 20 weeks gestation, it is referred to as a complete miscarriage. 

Incomplete miscarriage

A miscarriage will be labeled incomplete if some of the pregnancy tissue is retained in the uterus. In this case, a procedure will likely be necessary to remove the retained tissue if it does not pass naturally. 

Threatened miscarriage

When the cervix remains closed, and the fetal heartbeat can still be detected even though bleeding is experienced during early pregnancy, it is sometimes referred to as a threatened miscarriage. If very early in pregnancy, the bleeding may be related to the implantation of the fertilized egg. 

Missed miscarriage

A missed miscarriage has occurred if the pregnancy was previously progressing normally, but it is discovered that no fetal heartbeat is detected. With a missed miscarriage the fetus and the placenta have not yet been expelled, and medical intervention is often needed. 

Recurrent miscarriage

If a woman has experienced three or more miscarriages in a row, it is referred to as recurrent miscarriage. 

Causes of miscarriage

Many factors have been connected with an increased risk of miscarriage. Though in the majority of cases a cause of miscarriage is never determined. 

Chromosomal abnormality

Approximately 50% of miscarriages are due to chromosomal abnormalities. In the majority of cases, these chromosomal abnormalities are not related to abnormalities in a parent, but rather occurred during the development of the egg or the sperm, or at the time of fertilization. If a pregnancy is not developing normally, a chromosomal abnormality is often the body's way of ending the pregnancy. 

Health conditions

Health conditions such as immune system disorders, hormonal irregularities, uncontrolled diabetes, kidney disease, heart disease, and infection contracted during pregnancy can increase the risk of a pregnancy ending in miscarriage.   

Medication

Certain medications are not advised during pregnancy and if used, can increase the risk of miscarriage. Consult your healthcare provider if you’re unsure whether a prescription or over-the-counter medication can be continued throughout pregnancy. 

When to see the doctor for miscarriage

If you are experiencing any of the signs and symptoms of miscarriage, contact your doctor as soon as possible. Every pregnancy is different, and factors such as your week of gestation, maternal age, and severity of symptoms will help your doctor determine if medical intervention is needed. 

Diagnosing miscarriage

If a healthcare provider suspects that a miscarriage has occurred or is occurring, they will generally perform a pelvic ultrasound and exam to check for the fetal heartbeat and to detect whether the cervix is open or closed. In certain cases, blood tests may be performed to check the beta hCG, also known as the pregnancy hormone, levels. 

These procedures and tests will help the doctor determine if a miscarriage is occurring, and if so, what type and what stage of the process you are in. 

Treatments for miscarriage

When treating a miscarriage, there are two focuses — emotional health and physical health. 

When it comes to physical health, your provider will likely prioritize preventing infection and hemorrhaging. If the fetal tissue is expelled fully, further medical intervention is typically not required. If fetal tissue is not expelled completely, a procedure known as dilation and curettage, or D & C, is likely to be performed. 

Medication for pain may be prescribed and patients will likely be instructed to monitor their level of bleeding for several days and to contact their health care provider if bleeding intensifies.  

Miscarriage often takes a great emotional toll on the woman or couple. Everyone reacts and processes differently, but anxiety, depression, anger, and grief are common. Couples often don’t feel ready to move forward for a year or more after the miscarriage, so take the time you need to heal.

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Medically Reviewed on 3/10/2021
References
American Pregnancy Association: “Signs of Miscarriage.”

American Pregnancy Association: “Stillbirth: Trying to Understand.”

Georgetown University School of Nursing and Health Studies: “Miscarriage Recovery: A Woman’s Body and Self-Perception.”

Harvard Health Publishing: “Miscarriage.”