Women's  Healthcare Topics is a website about pregnancy and your newborn baby.

Miscarriage

Reviewed by James Brann, M.D.

What is a Miscarriage?

Learn the symptoms of a miscarriage.

A miscarriage is the spontaneous end of a pregnancy. It can occur at a stage where the embryo or fetus is incapable of surviving, generally occurring prior to 20 weeks of pregnancy. A miscarriage is the most common complication of early pregnancy.


What are the symptoms of miscarriage?

You may notice that your earlier pregnancy symptoms (eg, nausea, breast tenderness) have abated and you don't "feel pregnant" anymore. Vaginal bleeding may not occur, but it is usually present. The bleeding can be painless or associated with painful cramping. At the end of a miscarriage your symptoms are similar to a heavy period. Cramping is usually severe and the bleeding is heavy. You may also notice passing tissue.

Is there something wrong with us?

Usually there is nothing wrong with you and your partner. Half of all miscarriages are due to genetic problems that you are not responsible for. Most of the genetic (genes on the chromosomes) problems are not passed from the parents, they just happen by chance.

Why did this happen?

A common question after having a miscarriage is "why did it happen?" It is very difficult to answer this question with certainty. Many factors may contribute to the miscarriage but discerning the exact cause is difficult.

What are common causes of miscarriage?

  • Chromosomal - About half of all miscarriages are due to genetics (chromosomal and gene abnormalities). One common cause of miscarriage caused by genes is called a "blighted ovum". In this situation your pregnancy seems to develop normally. You feel pregnant and have the symptoms of being pregnant, but the bag of water (gestational sac) develops without the baby. When your doctor performs an ultrasound you can see the bag of water (the gestational sac) without the baby. Because you feel pregnant and still have all the pregnancy symptoms it is hard to accept that you are going to start cramping, bleeding and eventually miscarry.

  • Medical problems - Many common medical problems can cause a miscarriage. The most common medical problems associated with miscarriages include uncontrolled diabetes, chronic hypertension and thyroid disease.

  • Physical problems - A uterine fibroid, uterine septum and abnormal uterine shape can prevent the embryo from attaching to the uterus and lead to miscarriages.

  • Uterine infections - Pregnancy complicated by uterine infections such as PID (pelvic inflammatory disease) can increase your chances of having a miscarriage.

  • IUD (contraceptive) - If you use the contraceptive device called an “IUD” and get pregnant, this will increase your chances of a miscarriage. The risk of miscarriage with an IUD is 40 to 50%.

  • Incompetent cervix - Most miscarriages are associated with cramping pain, but a miscarriage caused from an incompetent cervix has no pain. With this type of miscarriage the cervix cannot hold the pregnancy and it will begin to open. Miscarriages that are caused from an incompetent cervix are usually seen after 14 weeks of pregnancy.

What are the risks factors for a miscarriage?

There are many associated risk factors that increase your chances of miscarriage.

  • Caffeine – Your risk of miscarriage will increase if you consume about 500mg of caffeine per day. This equals about 5 cups of coffee or thirteen 12 oz. cans of caffeinated soda.

  • Age – Your risk of miscarriage goes up as you become older. This increase in risk starts after 35 years of age.

  • Smoking – Smoking is not a good health choice for anyone. If you smoke more than 10 cigarettes per day you will increase your risk for miscarriage.

  • Alcohol – Your risk of miscarriage will double if you drink 30 ounces of alcohol per month.

It is advised that pregnant women limit their intake of caffeinated beverages, do not smoke or have any alcohol in pregnancy.

What happens if I have a miscarriage?

There are three possible treatment options for a miscarriage. Most women that miscarry do not need any treatment. If you are not bleeding too heavy and have no signs of infection your doctor may keep you under observation until you have passed all of the tissue.

Because sometimes a miscarriage can be a very long process and can take a couple of weeks most patients ask for help to speed up this process. A surgical procedure called a D & C (dilation and curettage) can be performed and the products of conception (embryo or fetus) are removed from the uterus.

The D & C is performed in the hospital under a general anesthetic and when you wake up you can go home. After the procedure you may have a little cramping and minimal bleeding.

The last treatment option is to take a medicine that causes your uterus to cramp and pass the tissue. The cramping can be severe until the tissue is completely passed and you may experience heavy bleeding.

Following your miscarriage you will be instructed to avoid anything placed in the vagina for two weeks. This includes using tampons and also having sexual intercourse. Note: If your blood type is Rh negative you will be given an injection of RhoGAM as a precaution against a situation called Rh incompatibility which could affect future pregnancies.

What happens after the miscarriage?

Having a miscarriage is difficult physically and emotionally. Your body will have experienced many hormonal changes during this time. Your feelings will include sadness and grief. Understand that this is a normal reaction and that it can become quite intense. If you feel like you are developing depression please contact your physician for help. Within two weeks after a miscarriage you will want to follow up with your doctor. Contact your doctor earlier if you have signs of heavy bleeding, burning with urination, severe cramping, or fever. At this appointment you may want to discuss how long to wait before conceiving again.

When can we try to get pregnant again?

It is common for patients to want to know when they may conceive again. It is advised to wait for one completely normal menstrual period before attempting to conceive again. Women have traditionally been told to wait at least two or three normal cycles, but several studies have shown no increased risks with waiting the shorter time interval.

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