Miscarriage is the spontaneous loss of a pregnancy before the 20th week. About 15 to 20 percent of known pregnancies end in miscarriage. But the actual number is probably much higher because many miscarriages occur so early in pregnancy that a woman doesn't even know she's pregnant. Most miscarriages occur because the fetus isn't developing normally.
Miscarriage is a relatively common experience — but that doesn't make it any easier. Take a step toward emotional healing by understanding what can cause a miscarriage, what increases the risk and what medical care might be needed.
Sadly, miscarriages are a very common occurrence. Sources vary, but many estimate that approximately 1 in 4 pregnancies end in miscarriage; and some estimates are as high as 1 in 3. If you include loss that occurs before a positive pregnancy test, some estimate that 40% of all conceptions result in loss.
Although statistics can vary slightly from one source to the next, here is a general account (based primarily on information provided by the March of Dimes) of the frequency of miscarriages in the United States:
There are about 4.4 million confirmed pregnancies in the U.S. every year.
900,000 to 1 million of those end in pregnancy losses EVERY year.
More than 500,000 pregnancies each year end in miscarriage (occurring during the first 20 weeks).
Approximately 26,000 end in stillbirth (considered stillbirth after 20 weeks)
Approximately 19,000 end in infant death during the first month.
Approximately 39,000 end in infant death during the first year.
Approximately 1 in 4 pregnancies end in miscarriage; some estimates are as high as 1 in 3. If you include loss that occurs before a positive pregnancy test, some estimate that 40% of all conceptions result in loss.
Approximately 75% of all miscarriages occur in the first trimester.
An estimated 80% of all miscarriages are single miscarriages. The vast majority of women suffering one miscarriage can expect to have a normal pregnancy next time.
An estimated 19% of the adult population has experienced the death of a child (this includes miscarriages through adult-aged children).
The most common symptom of miscarriage is vaginal bleeding. This can vary from light spotting or brownish discharge, to heavy bleeding and bright red blood. The bleeding may come and go over several days (spotting or bleeding in early pregnancy is fairly common).
Light vaginal bleeding is common during the first trimester of pregnancy (the first 12 weeks), so having this symptom does not necessarily mean that you have had a miscarriage. In most cases, women who experience light bleeding in the first trimester go on to have successful pregnancies. Sometimes even heavier bleeding doesn't result in miscarriage.
However, if you have vaginal bleeding, contact your maternity team or early pregnancy unit at your local hospital straight away.
Other symptoms of a miscarriage include:
cramping and pain in your lower abdomen
a discharge of fluid from your vagina
a discharge of tissue from your vagina
no longer experiencing the symptoms of pregnancy, such as feeling sick and breast tenderness
On rare occasions, miscarriages happen because the pregnancy develops outside the womb. This is known as an ectopic pregnancy. Ectopic pregnancies are potentially serious because there is a risk that you could experience internal bleeding.
Symptoms of an ectopic pregnancy include:
heavy vaginal bleeding (soaking more than one sanitary pad every hour)
persistent and severe abdominal pain
pain in your shoulder tip
feeling very faint and light-headed, and possibly fainting
Symptoms of an ectopic pregnancy usually appear between weeks 5-14 of the pregnancy.
If you experience any of the symptoms above, seek immediate medical attention.
Vaginal bleeding can also be caused by a molar pregnancy. This is a pregnancy that has not developed normally, resulting in a mass of abnormal cells within the womb instead of a baby. A molar pregnancy is usually identified during the first ultrasound scan, at 10-16 weeks of pregnancy.
Call your doctor if you experience:
Bleeding, even light spotting
A gush of fluid from your vagina without pain or bleeding
Passing of tissue from the vagina
You may bring any tissue that is passed into your doctor's office in a clean container. It's unlikely that any testing would define a cause, but confirming the passage of placental tissue helps your doctor determine that your symptoms aren't related to a tubal (ectopic) pregnancy.
If a miscarriage happens during the first trimester of pregnancy (the first three months), it is usually due to problems with the unborn baby (fetus).
If a miscarriage happens during the second trimester of pregnancy (between weeks 14 and 26), it is usually the result of an underlying health condition in the mother.
Most first trimester miscarriages are caused by problems with the chromosomes of the fetus.
Chromosomes are blocks of DNA. They contain a detailed set of instructions that control a wide range of factors, from how the cells of the body develop to what color eyes a baby will have.
For a pregnancy to be successful, a fetus needs to have 46 chromosomes in total:
23 are from the father's sperm
23 are from the mother's egg
Sometimes, something can go wrong at the point of conception and the fetus receives too many or not enough chromosomes. The reasons for this are often unclear, but it means that the fetus will not be able to develop normally, resulting in a miscarriage.
It is estimated that up to two thirds of early miscarriages are associated with chromosome abnormalities.
The placenta is the organ that links the mother's blood supply to her baby's. If there is a problem with the development of the placenta it can also lead to a miscarriage.
An early miscarriage may happen by chance or unknown reasons. However, there are several known risk factors which increase the risk of problems occurring.
One of the most important risk factor for miscarriage is the age of the mother:
In women under 30, 1 in 10 pregnancies will end in miscarriage.
In women aged 35-39, up to 2 in 10 pregnancies will end in miscarriage.
In women over 45, more than half of all pregnancies will end in miscarriage.
Other risk factors for having a miscarriage include:
obesity
smoking during pregnancy
drug misuse during pregnancy (particularly cocaine)
drinking more than 200mg of caffeine a day: one mug of tea contains around 75mg of caffeine, and one mug of instant coffee contains around 100mg of caffeine
drinking more than two units of alcohol a week: one unit is half a pint of bitter or ordinary strength lager, a small glass of wine or a 25ml measure of spirits
There are several long-term (chronic) health conditions that can increase the risk of having a miscarriage. These are:
diabetes (if it is poorly controlled)
severe high blood pressure (hypertension)
lupus (a condition where the immune system attacks healthy tissue)
kidney disease
an overactive thyroid gland (hyperthyroidism)
an underactive thyroid gland (hypothyroidism)
celiac disease (a condition that affects the digestive system)
There are some infections that may increase the risk of having a miscarriage. These include:
rubella (German measles)
cytomegalovirus
toxoplasmosis (a bacterial infection)
a bacterial infection of the vagina called bacterial vaginosis
HIV
sexually transmitted infection such as chlamydia, gonorrhea and syphilis
malaria (a tropical disease spread by mosquitoes)
Some medicines can also increase the risk of miscarriage:
misoprostol (used for conditions such as rheumatoid arthritis)
retinoids (used for eczema and acne)
methotrexate (used for conditions such as rheumatoid arthritis)
non-steroidal anti-inflammatory drugs (used for pain and inflammation)
To be sure that a medicine is safe in pregnancy, always check with your doctor, midwife or pharmacist before taking it.
Antibodies are proteins that are produced by the immune system (the body's natural defense system) to fight infection.
Some women who have had three or more miscarriages in a row (recurrent miscarriages) have a higher than usual level of an antibody called antiphospholipid (aPL) in their blood. The aPL antibodies are known to cause blood clots. These blood clots can block the supply of blood to the fetus, which can cause a miscarriage.
Having a high number of aPL antibodies in your blood is known as Hughes syndrome.
Problems and abnormalities with the womb can also lead to second trimester miscarriages. Possible problems with the structure of the womb include:
non-cancerous growths in the womb called fibroids
scarring on the surface of the womb
In some cases, the muscles of the cervix (neck of the womb) are weaker than usual. This is known as a weakened cervix or cervical incompetence. A weakened cervix may be due to a previous injury to this area, or may have been something you were born with.
The muscle weakness can cause the cervix to open too early during pregnancy, leading to a miscarriage.
Prolactin is a hormone which is produced during pregnancy. Prolactin helps to prepare the breasts for breastfeeding. Sometimes, women have a higher level of prolactin in their body than usual. This is known as hyperprolactinaemia.
Some limited evidence suggests that hyperprolactinaemia may be linked to an increased risk of miscarriage.
Polycystic ovary syndrome (PCOS) is a condition where the ovaries are larger than normal. It can lead to hormonal imbalances inside the womb.
Polycystic ovary syndrome is known to be a leading cause of infertility. There is some evidence to suggest that it may also be linked to an increased risk of miscarriage in women who are still fertile. However, the exact role that polycystic ovary syndrome plays in miscarriages is unclear.
There are a number of widely held assumptions about the possible causes of miscarriages. However, there is no evidence to support such claims.
An increased risk of miscarriage is not linked to:
a mother's emotional state during pregnancy, such as being stressed or depressed
having a shock or fright during pregnancy
exercise during pregnancy (but discuss what type of exercise is suitable for you during pregnancy with your doctor or midwife)
lifting or straining during pregnancy
working during pregnancy
having sex during pregnancy
Most of the time, a first-trimester miscarriage is a tragic but relatively uncomplicated event from a health perspective -- your body recovers fairly quickly and you can go on to get pregnant again without further concerns. Sometimes, however, complications can arise. Make sure to see your doctor if you suspect you have any of these problems.
Incomplete Miscarriage: An incomplete miscarriage means that you still have tissue retained in your uterus from the pregnancy. Sometimes this condition will resolve on its own, but other times you might need a D&C (Dilation and Curettage).
Excessive Bleeding: The general rule is that if you're soaking through a menstrual pad in under an hour, you should seek medical attention immediately. A small percentage of women have hemorrhaging as a complication of miscarriage.
Infection: A post-miscarriage infection can be dangerous but is easily treated with antibiotics. Be sure to contact your doctor if you think you have symptoms of an infection after miscarriage.
Depression: Grief is a normal reaction to miscarriage and pregnancy loss. But if you start to show signs of clinical depression, it could be helpful to talk to a counselor or other mental health professional.
Anxiety Disorders: Even more common than clinical depression after miscarriage are anxiety and stress disorders. It is even possible to develop symptoms of post-traumatic stress disorder (PTSD) after a miscarriage.
Recurrent Miscarriages: Sadly, some women will have more than one miscarriage. If you have two or three consecutive miscarriages, it can be a good idea to talk to a doctor about testing for possible causes.
Asherman's Syndrome: Asherman's syndrome is a rare complication of a D&C. The syndrome involves scarring and adhesions in the uterus that can cause fertility problems and further miscarriages.
Some women who miscarry develop a uterine infection, also called a septic miscarriage. Signs and symptoms of this infection include:
Fever
Chills
Body aches
Thick, foul-smelling vaginal discharge
Your treatment for a miscarriage depends on whether there is any foetal tissue left in your womb (a complete or incomplete miscarriage).
If there is no fetal tissue left in your womb (a complete miscarriage), no further medical treatment is required. However, a miscarriage can have a significant emotional effect and you and your partner may need counseling or support.
If there is fetal tissue left in your womb (an incomplete miscarriage), this needs to be removed as there is a risk that it could become infected. This can be done in three ways:
using minor surgery to remove the tissue
using medication to remove the tissue
waiting for the tissue to pass naturally out of your womb (expectant management)
There are benefits and risks of each option that you should consider when making your decision.
If you have surgery, any bleeding or pain you are experiencing because of your miscarriage should quickly improve. However, all surgical procedures carry their own risks. Medication avoids the need for surgery but can cause increased pain and bleeding. Waiting for the tissue to pass naturally avoids taking medication or having surgery, but can take several weeks. It is also possible that not all of the tissue will be removed, and that you will later require surgery.
Discuss the options with the doctor in charge of your care.
Surgery usually takes place within a few days of a miscarriage. However, there are circumstances where you may be advised to have immediate surgery, including:
if you experience continuous heavy bleeding
if there is evidence that the fetal tissue has become infected
if medication or waiting for the tissue to pass out naturally have been unsuccessful
Surgery is usually performed under general anesthetic. Your cervix (neck of the womb) will be opened with a small tube, known as a dilator, and the tissue will be removed using a suction device. This type of surgery is known as evacuation of retained products of conception (ERPC).
Before surgery, you may be given medication to soften the cervix and to make it easier to perform the surgery.
This type of surgery is
usually very safe. However, as with all surgery, there is a small
risk of complications.
Possible complications include:
infection
excessive bleeding
the womb or cervix being torn during the procedure: this may require further surgery to repair it
Around 2 in 100 women will experience a serious complication, such as a tear to their womb or cervix.
Using medication to remove the tissue involves taking tablets that cause the cervix to open, allowing the tissue to pass out. There are two types of tablets:
tablets that you swallow
tablets called pessaries that are inserted directly into your vagina, where they dissolve
The effects of the tablets usually begin within a few hours. You will experience symptoms similar to a heavy period, such as cramping and heavy vaginal bleeding. You may also experience vaginal bleeding for up to three weeks.
Medication is successful in removing fetal tissue in around 9 out of 10 cases. However, you will need to have surgery if the medication is unsuccessful.
If you wait for the tissue to pass naturally out of your womb, it may be some time before you experience vaginal bleeding. This tends to be heavier than your usual period and you may also experience cramping. Bleeding can last for up to three weeks.
If the bleeding becomes particularly heavy or you experience severe pain, contact your hospital. You should be given a 24-hour helpline number to call in case of emergency.
For more than half of miscarriages, this method is unsuccessful in removing fetal tissue. In this situation, you will need either medication or surgery.
In some cases, if a cause of the miscarriage has been identified, it may be possible to have treatment to prevent this causing any more miscarriages.
Hughes syndrome, an autoimmune condition that causes blood clots, can be treated with medication. Research has shown that a combination of aspirin and heparin (a medicine used to prevent blood clots) can improve pregnancy outcomes in women with Hughes syndrome.
A weakened cervix, also known as cervical incompetence, can be treated with an operation to put a small stitch of strong thread around your cervix to keep it closed. This is usually carried out after the first 12 weeks of your pregnancy, and is removed around week 37.
Other suggested treatments for recurrent miscarriages have been studied. These include:
hormone treatments during pregnancy
using specially modified antibodies during pregnancy
taking vitamin supplements during pregnancy
However, the results of all these studies have been disappointing so far and there is no evidence that these treatments can prevent miscarriages.
Physical recovery from miscarriage in most cases will take only a few hours to a couple of days. Expect your period to return within six weeks. In the meantime, call your doctor if you experience heavy bleeding, fever, chills or severe pain. These signs and symptoms could indicate an infection. Avoid having sex or putting anything in your vagina — such as a tampon or douche — for two weeks after a miscarriage.
It's possible to become pregnant during the menstrual cycle immediately after a miscarriage. But if you and your partner decide to attempt another pregnancy, make sure you're physically and emotionally ready. Your doctor may recommend waiting at least one menstrual cycle, if not longer.
If you experience multiple miscarriages, generally more than three in a row, consider testing to identify any underlying causes - such as uterine abnormalities, coagulation problems or chromosomal abnormalities. In some cases your doctor may suggest testing after two consecutive losses, but two losses are still often due to genes and not to an underlying medical cause. If the cause of your miscarriages can't be identified, don't lose hope. Even without treatment, about 70 percent of women with repeated miscarriages go on to have successful pregnancies.
Emotional healing may take much longer than physical healing. Miscarriage can be a heart-wrenching loss that others around you may not fully understand. Your emotions may range from anger to despair. Give yourself time to grieve the loss of your pregnancy, and seek help from those who love you. Keeping the loss to yourself isn't necessary.
You'll likely never forget your hopes and dreams surrounding this pregnancy, but in time acceptance may ease your pain. Talk to your doctor if you're feeling profound sadness or depression.
In the vast majority of cases, there's nothing you can do to prevent a miscarriage. Simply focus on taking good care of yourself and your baby. Seek regular prenatal care, and avoid known risk factors — such as smoking and drinking alcohol. If you have a chronic condition, work with your health care team to keep it under control.
Even if you take the best care of yourself during pregnancy, you often can't prevent a miscarriage.
However, there are ways to lower your risk of miscarriage:
Do not smoke during pregnancy.
Do not drink alcohol during pregnancy.
Do not use drugs during pregnancy.
Drink at least 1.2 litres (six to eight glasses) of fluids, such as water and fruit juice, every day.
Eat a healthy, balanced diet with at least five portions of fruit and vegetables a day.
Obesity increases your risk of miscarriage. A person is obese when they have a body mass index (BMI) of over 30. You can check your BMI using the healthy weight calculator. However, if you are pregnant the calculator may not be accurate, so you should consult your midwife or doctor instead.
The best way to protect your health and your baby's wellbeing is to lose weight before you become pregnant. By reaching a healthy weight, you cut your risk of all the problems that are associated with obesity in pregnancy. Contact your GP for advice about how to lose weight. They may be able to refer you to a specialist weight-loss clinic.
As yet, there is no evidence to suggest that losing weight during pregnancy will lower your risk of miscarriage, but eating healthily and activities such as walking and swimming are good for all pregnant women. If you were not active before becoming pregnant, you should consult your midwife or doctor before starting a new exercise regime while you are pregnant.
Read more on if you're pregnant and overweight and find out about exercises and keeping active during pregnancy.
Various factors increase the risk of miscarriage, including:
Age. Women older than age 35 have a higher risk of miscarriage than do younger women. At age 35, you have about a 20 percent risk. At age 40, the risk is about 40 percent. And at age 45, it's about 80 percent. Paternal age also may play a role. Some studies indicate that the chance of miscarriage is higher if a woman's partner is age 35 or older, with the chance increasing as men age.
Previous miscarriages. The risk of miscarriage is higher in women with a history of more than one previous miscarriage. After one miscarriage, your risk of miscarriage in a future pregnancy is about the same as women who have never had a miscarriage — 20 percent. After two miscarriages, your risk increases to about 28 percent.
Chronic conditions. Women with certain chronic conditions, such as diabetes or thyroid disease, have a higher risk of miscarriage.
Uterine or cervical problems. Certain uterine abnormalities or a weak or unusually short cervix may increase the risk of miscarriage.
Smoking, alcohol and drugs. Women who smoke or drink alcohol during pregnancy have a greater risk of miscarriage than do nonsmokers and women who avoid alcohol during pregnancy. Drug use also increases the risk of miscarriage.
Invasive prenatal tests. Some prenatal genetic tests, such as chorionic villus sampling and amniocentesis, carry a slight risk of miscarriage.