Quick look at miscarriage
Miscarriage is the spontaneous loss of a pregnancy during the first trimester.
Signs of miscarriage include bleeding, abdominal cramping, and vaginal discharge of fluid and/or tissue.
Risk factors for miscarriage include age, history of previous miscarriage(s), certain lifestyle factors, obesity or low body weight, and underlying health conditions.
Recurrent miscarriage, which is two or more miscarriages occurring one after the other, may indicate a more serious medical problem such as infertility.
Emotional distress and grief sometimes accompany a miscarriage. These feelings are normal and will likely improve with time. Some women find it helpful to process these feelings with their partner, friends or a therapist.
What is miscarriage?
Miscarriage refers to spontaneous early pregnancy loss occurring during the first trimester (13 weeks) of pregnancy. Miscarriage occurs in at least 10 percent of pregnancies in which a woman knows she is pregnant. However, up to 50 percent of fertilized eggs spontaneously abort, often before a woman is aware she was pregnant.
While miscarriages can be emotionally devastating, they are very common. Most women who experience this type of pregnancy loss go on to have a healthy pregnancy in the future, and can start trying to get pregnant again as soon as they feel ready.
The majority of miscarriages are caused by abnormal chromosomes in the embryo. Chromosomes are the part of a cell that contain genetic information. When there is a defect or abnormality in an embryo caused by a chromosomal abnormality, the pregnancy will often self-terminate. Other less common causes of miscarriage include maternal illness, hormone disorders, structural abnormalities within the cervix or uterus, and certain lifestyle factors.
Loss of pregnancy experienced during the second and third trimesters are far less common, and are generally not classified as miscarriages. Instead, a pregnancy loss experienced outside of the first trimester is called a stillbirth.
Signs of miscarriage
Symptoms of a miscarriage may include:
- Vaginal bleeding
- Abdominal cramping
- Discharge of fluid or tissue
- Loss of pregnancy symptoms like morning sickness and breast tenderness (although many women experience improvement in these symptoms as their healthy pregnancy progresses).
Some women experience light bleeding and spotting during the first trimester of a healthy pregnancy, so bleeding does not necessarily indicate a miscarriage. If a woman suspects she is having a miscarriage, she should contact her OB-GYN to discuss the symptoms and set up an appointment if needed.
More severe symptoms such as intense abdominal pain located on one side, heavy bleeding, dizziness and fainting may indicate a potentially serious condition called ectopic pregnancy. An ectopic pregnancy is when an embryo implants in one of the fallopian tubes rather than in the uterus.
An ectopic pregnancy can be life threatening and cannot be carried to term. A woman exhibiting signs of an ectopic pregnancy should contact her doctor immediately. In some cases, urgent medical or surgical treatment may be advised.
Risk factors for miscarriage
There is a chance of miscarriage in every pregnancy, and often a specific cause cannot be identified. With this in mind, a woman who has experienced a miscarriage need not feel guilt or shame. Most miscarriages occur due to factors completely outside of her control.
Contrary to myths and misconceptions, miscarriages are not caused by strenuous exercise, working, falling, stress, lifting something heavy or having intercourse. Rather, the below factors are known to increase a woman’s risk for miscarriage.
Starting at age 30 and increasing after age 35, women have a higher chance of ovulating a genetically abnormal egg during any given month. This increases the risk of miscarriage.
Previous recurrent miscarriages
If a woman has had two or more consecutive (recurrent) miscarriages, the risk of another one is increased. In these cases, testing and evaluation may be advised in order to determine an underlying cause or diagnose infertility. For the majority of women, miscarriage is an isolated event, and they can go on to have one or more healthy pregnancies afterward.
Smoking and substance abuse
Women who smoke during pregnancy are at an increased risk of miscarriage. So too are women who use illicit drugs or consume alcohol (particularly in excess) while pregnant. Women who are actively trying to conceive are advised to stop smoking, drinking, and using illicit substances.
Certain prescriptions and over-the-counter medications should also be avoided once a woman starts trying to get pregnant. Safety of prescribed medications should be reviewed with an OB-GYN prior to conception.
Being obese or underweight has been shown to increase a woman’s risk for miscarriage.
Maternal illness and other health conditions
Sometimes, a mother’s underlying health conditions can cause or contribute to miscarriage. These include certain infections, STDs (sexually transmitted diseases), problems with the uterus or cervix, hormonal disorders and untreated diabetes.
Miscarriage diagnosis and treatment
Many women will not require any medical treatment during or following a miscarriage. However, if a woman suspects she is having or has had a miscarriage, she should contact her healthcare provider. Depending on the described symptoms, her doctor may advise her to come in for a visit, during which diagnostic procedures such as an ultrasound exam or blood test can help determine whether or not pregnancy loss has occurred.
An incomplete miscarriage, in which some tissue from the pregnancy remains in the uterus, may require medical treatment. There are several safe and effective surgical methods used to remove the remaining tissue, if necessary, as well as nonsurgical options such as medications that help the body expel the tissue on its own.
Alternatively, the patient and doctor may come to a shared decision to wait and see if the tissue passes on its own. This “wait and see” approach is sometimes called expectant care.
Emotional effects of miscarriage
While miscarriage is a common experience shared by many women, it is still often a very difficult and trying one. The physical loss of pregnancy may be accompanied by grief, sadness and distress. Women are encouraged to talk about these feelings with their partner, their friends or a professional therapist. Miscarriage support groups such as those organized by Share Pregnancy and Infant Loss Support, Inc. may also be helpful.