Miscarriage

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KEY POINTS

• A miscarriage is the unplanned loss of a baby before the 20th week of pregnancy. If you have had a miscarriage, it’s unlikely that you did anything to cause it.
• Miscarriage may be your body's way of ending a pregnancy that is not developing normally. It may happen because there is something wrong with the baby such as a genetic problem.
• Ask your healthcare provider how to take care of yourself at home, and what symptoms or problems you should watch for, and what to do if you have them.

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What is a miscarriage?

A miscarriage is the unplanned loss of a baby before the 20th week of pregnancy. At least 10 to 15 of every 100 pregnancies end in miscarriage. Most miscarriages happen during the first 10 to 15 weeks. Some women miscarry even before they know they are pregnant. A menstrual period that is late and heavier than usual may be the only symptom.

Having your pregnancy end in a miscarriage can be very sad and distressing. If you have had a miscarriage, it’s unlikely that you did anything to cause it. There is a good chance that you will be able to have a baby the next time you are pregnant.

What is the cause?

Often you will not know what caused a miscarriage. Miscarriage may be your body's way of ending a pregnancy that is not developing normally. It may happen because there is something wrong with the baby such as a genetic problem.

Other possible causes of miscarriage include infections or problems in the uterus, uncontrolled diabetes, or hormonal imbalances. Cigarette smoking, alcohol, and illegal drugs such as cocaine, can also cause miscarriage. This is especially true in early pregnancy, when major organs of the baby are developing.

A problem with the cervix sometimes causes a miscarriage. The cervix is the opening of the uterus into the birth canal. During labor the cervical opening gets bigger so that the baby can pass into the birth canal. If the cervix starts opening too early in the pregnancy, there is a risk of miscarriage. Often, if the problem is found early, it can be treated and the pregnancy can continue.

Mild falls, exercise, and sex don’t cause a miscarriage. The baby is well protected in the uterus.

What are the symptoms?

Symptoms may include:

• Bleeding from the vagina. It can range from a few drops of blood to a heavy flow. The bleeding may start with no warning, or you may first have a brownish discharge.
• Cramps in your lower belly
• A gush of fluid from the vagina without bleeding or pain. This may mean that your bag of water has broken.
• Passing tissue from your uterus. If solid material passes from your vagina, try to keep it so that your healthcare provider can examine it.

It’s possible to have a miscarriage without any bleeding or pain. The baby may have never developed. The only sign of miscarriage may be that you stop having symptoms of pregnancy. This condition is called a missed miscarriage.

You can have signs of miscarriage without actually losing the baby. This is called a threatened miscarriage. If you have signs of a miscarriage but you have not yet lost the baby, there is a chance that your pregnancy will continue normally.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. You may have tests such as:

• A pelvic exam to check your uterus and cervix
• An ultrasound, which uses sound waves to show pictures of your uterus and organs around it. It can show if the baby is still in your uterus or if the baby started growing outside the uterus. It may show that the pregnancy never developed into a baby.
• Blood tests

How is it treated?

If you have a threatened miscarriage, your provider may suggest that you:

• Rest in bed for 1 to 2 days
• Stop exercise
• Stay off your feet as much as possible
• Not have sex until your provider says it’s safe

If the cervix is opening too early, your healthcare provider may stitch the cervix closed until it’s time for your baby to be born. The stitch is called a cerclage. If your uterus or cervix is abnormal, your healthcare provider may prescribe a long period of bed rest and medicines to keep you from having contractions. It may not be possible to stop a miscarriage if you are having bleeding and cramping and the cervix starts to open.

If you miscarry, or have a missed miscarriage, you may need a procedure or medicine to remove pregnancy tissue that is still in the uterus. You may have a dilation and curettage (D&C) to gently scrape tissue from the lining of the uterus, or your provider may suction the tissue.

Depending on your blood type, your healthcare provider may want to give you a shot that protects against a problem called Rh incompatibility. This is a problem that might affect future pregnancies. It can happen if your Rh blood type is different from the blood type of the baby.

What happens after a miscarriage?

Recovery usually takes 4 to 6 weeks. You may have a small amount of bleeding and discomfort for a few days. If you were pregnant for more than 13 weeks before the miscarriage, you may look pregnant for a short while and your breasts may leak milk.

Grief, anger, and feelings of guilt are common and normal reactions to a miscarriage. Allow yourself to grieve over the loss of the baby. Look for support from friends. You may find it helpful to talk to others who have had miscarriages. You may be afraid that you won't be able to have a baby, but for most women, the next pregnancy is normal.

Some women do have repeated miscarriages. A series of 3 or more miscarriages is called habitual miscarriage. These miscarriages may be caused by an imbalance of hormones or other conditions that can be treated. If you have several miscarriages, you can work with your healthcare provider to try to find and treat the cause.

Ask your healthcare provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.