Women's Healthcare Topics

Second Trimester or Late Pregnancy Miscarriage

Reviewed by James Brann, M.D.

Causes of Second Trimester Miscarriages

A miscarriage at any stage in pregnancy is tough, but when you miscarry in the second trimester, it's devastating. While second trimester pregnancy losses do happen, they are relatively rare.

A majority of miscarriages (80 percent) occur in the first 13 weeks of your pregnancy week by week. Your risk of miscarrying at 16 weeks pregnant is less than 0.6 percent.

Half of all miscarriages that occur in the first trimester are due to chromosomal abnormalities in the baby. In the second trimester, roughly 24 percent of all miscarriages are due to chromosomal defects. Your risk decreases to 12 percent late in the second trimester of your pregnancy week by week.

Unhealthy lifestyle habits – such as moderate or heavy alcohol consumption, cocaine and illegal drug use, and heavy smoking – can contribute to second trimester miscarriage. But in a majority of the cases, women who miscarry in the middle part of pregnancy live a healthy lifestyle.

Miscarriages that occur in the second trimester can be caused by cervical insufficiency and a weakened cervix that dilates (or opens up) before the baby is ready for life outside the womb, maternal infections, and problems with the mother's uterus. In rare cases, diagnostic testing done in the second trimester, including chorionic villus sampling and amniocentesis, can induce a pregnancy loss. (Diagnostic testing carries a one percent miscarriage risk.)

Diabetes that is not well controlled can increase your risk of a second trimester miscarriage. In addition, if you suffer from thrombophilia or any other blood clotting diseases that make you more susceptible to blood clots, you're at elevated risk for miscarriage in the second trimester.

Neutral tube defects (such as spina bifida) and amniotic band syndrome (a rare pregnancy complication that is caused when parts of the amniotic sac starts to separate and entangle arms and legs, fingers and toes, and other parts of your baby's body) can also contribute to second trimester miscarriage.

Signs of a Potential Miscarriage

Try not to worry about miscarriages in the second trimester. Again, they are relatively rare. However, you will want to contact your doctor immediately if you experience any of the following symptoms:

  • Sudden gush of fluid from your vagina without any signs of bleeding

  • Passed fetal tissue from your vagina

  • Abdominal cramping, or abdominal pain

All of these symptoms are signs of a miscarriage. You will need to be treated right away. In a second trimester miscarriage, because your pregnancy is more advanced, you may need to be admitted to a hospital or a medical facility for treatment.

What Happens after a Second Trimester Miscarriage?

Learn about pregnancy loss with a second trimester miscarriage.

In most cases, your healthcare provider will give you medication (such as misoprostol), which will cause your body to expel any remaining fetal tissue. The medication will open your cervix and cause your uterus to contract. You will experience painful cramping and contractions during this process. Pain medication can help control the discomfort, but this process is still physically and emotionally unpleasant for many women.

At this late stage in pregnancy, the dilation and evacuation (D&E) procedure, which is used in early first trimester miscarriages, is not practical. It comes with more risks, such as damage to the uterus or cervix, and accidental nicks and cuts inside the womb.

D&E procedures can still be performed in the second trimester, however, due to the larger size of the baby, this surgical procedure requires more skill. Unfortunately, very few doctors and physicians are trained well enough to perform surgery at this stage.

If you experience a second trimester miscarriage, you should talk to your doctor about your options. He or she can give you more guidance.


Doctor's Corner

Pregnancy Week by Week - Women's Healthcare Topics