Miscarriage, also known as spontaneous abortion, is the unexpected end of a pregnancy before 20 weeks gestation. It is estimated that 10-25% of recognized pregnancies end in miscarriage, but the actual number may be higher when taking into account unrecognized pregnancies.
Despite being relatively common, a miscarriage can be an emotionally painful and traumatic experience.
This article will provide an in-depth look at miscarriage, covering the causes, risk factors, signs and symptoms, diagnosis, treatment options, and coping strategies. With information and support, it is possible to move forward after a miscarriage.
Table of Contents
What Causes Miscarriage?
There are several possible causes of miscarriage, although in many cases the exact cause cannot be identified. Some of the most common causes include:
- Chromosomal abnormalities: Approximately 60% of early miscarriages are due to chromosomal abnormalities in the fetus, usually occurring by chance during cell division. These abnormalities prevent normal development.
- Hormonal problems: Issues with hormones like progesterone can impair development and increase miscarriage risk. Low progesterone may fail to support the pregnancy.
- Uterine or cervical abnormalities: Defects in the structure of the uterus or weaknesses in the cervix can make miscarriage more likely.
- Chronic conditions: Health conditions like diabetes, thyroid disorders, or polycystic ovary syndrome increase miscarriage risk.
- Infections: Certain bacterial, viral or parasitic infections including listeria, toxoplasmosis, or rubella can be linked to pregnancy loss.
- Lifestyle factors: Smoking, alcohol abuse, drug use, high caffeine intake and exposure to environmental toxins are associated with increased risk.
- Maternal age: Risk rises as a woman gets older, especially after age 35. This may be due to egg quality declining with age.
- Trauma: Any trauma to the abdomen, like a car accident, can trigger miscarriage by harming the fetus.
Who Is at Risk For Miscarriage?
While any woman can experience pregnancy loss, there are some women with higher miscarriage risks than others. Risk factors include:
- Advanced maternal age (over 35 years old)
- History of previous miscarriages
- Chronic disorders like diabetes or autoimmune conditions
- Uterine or cervical abnormalities
- Smoking, alcohol or drug abuse
- Caffeine consumption over 300mg daily
- Environmental toxin exposure
- High stress levels
- Low progesterone levels
- Being underweight or overweight
- Conceiving within three months of giving birth
If you fall into any high-risk categories, talk to your doctor about steps you can take to minimize your chances of miscarriage. Taking proper precautions can help ensure a healthy pregnancy.
Signs and Symptoms of Miscarriage
The most common sign of a miscarriage is vaginal bleeding, which can vary from light spotting to heavy bleeding. The bleeding may be accompanied by abdominal or lower back pain and abdominal cramps. The pain can range from mild to severe, and may feel similar to menstrual cramps.
Other possible signs and symptoms include:
- Passing tissue or clots through the vagina
- Sudden decrease in signs of pregnancy like nausea or fatigue
- White-pink mucus discharge from the vagina
- No longer feeling pregnant or absence of fetal movement
- Fever or chills
If you experience any of these symptoms, contact your doctor right away to be evaluated. Bleeding and pain can quickly become severe, so prompt medical care is essential.
How is Miscarriage Diagnosed?
If you are experiencing bleeding, pain or other miscarriage symptoms, your doctor will use the following techniques to determine if you are having a miscarriage:
- Pelvic exam: Checking the cervix for dilation and assessing uterus size
- Ultrasound: Looking for fetal heart activity and monitoring growth
- Blood tests: Checking for falling hCG levels which may indicate pregnancy loss
- Tissue tests: Testing any expelled tissue to check for fetal chromosomal abnormalities
Your doctor may diagnose a miscarriage if there is no fetal heartbeat, no fetal growth between ultrasounds, or abnormally dropping hCG levels. Talk to your doctor about any concerns you may have about your pregnancy.
Types of Miscarriage
There are several classifications of miscarriage that provide information about timing:
- Chemical pregnancy: The fertilized egg fails to implant properly in the uterus, causing very early pregnancy loss. This may happen before any symptoms are noticed.
- Missed miscarriage: The embryo dies but tissue remains in the uterus for days or weeks. Bleeding and cramping eventually occur to expel the tissue.
- Inevitable miscarriage: Unpreventable pregnancy loss. Abdominal pain and bleeding will continue until all tissue passes.
- Incomplete miscarriage: Only some products of conception are expelled, and bleeding continues until the uterus is emptied. Additional medical care is often needed.
- Complete miscarriage: All fetal tissue is expelled naturally without complication.
- Recurrent pregnancy loss: Defined as three or more consecutive miscarriages. Testing is done to identify any underlying causes.
- Septic miscarriage: Miscarriage accompanied by a uterine infection requiring urgent medical treatment. This is rare but dangerous.
Treatment Options After Miscarriage
The treatment approach after a miscarriage depends on the individual situation:
- Wait and see: If a miscarriage is only suspected but not confirmed, waiting to see if bleeding resolves and pregnancy continues may be recommended.
- Medicine: Drug treatment with misoprostol helps empty the uterus to complete the miscarriage.
- Surgery: A dilation & curettage (D&C) surgically removes any remaining tissue from the uterus.
- Blood transfusion: Significant blood loss may require transfusion to replace blood cells and stop bleeding.
- Antibiotics: If any signs of infection like fever are present, antibiotics will be prescribed.
After going through the miscarriage itself, the recovery process can take time. Your doctor will explain what to expect physically and emotionally in the days and weeks following pregnancy loss.
Prevention of Future Miscarriage
If miscarriages are recurrent or unexplained, your doctor will investigate potential underlying causes like uterine abnormalities, hormonal imbalances, or genetic issues. Based on these findings, a management plan can be created to help prevent future miscarriage. Steps may include:
- Hormone supplements like progesterone to stabilize pregnancy
- Lifestyle improvements like quitting smoking, losing weight, reducing stress
- Prenatal vitamins with folic acid prior to conception
- Treatment of any underlying chronic medical conditions
- Correction of uterine defects found on imaging
- Genetic counseling prior to trying again
- Use of fertility treatments like IVF if needed
- More frequent prenatal checkups in subsequent pregnancies
By identifying and managing contributing factors, many couples can go on to have a successful pregnancy in the future. Discuss your history with your OB-GYN to develop an individualized prevention plan.
Emotional and Psychological Aspects of Miscarriage
Alongside the physical impact, a miscarriage can be extremely emotionally draining. Although pain and grief are normal reactions, those feelings should ease with time. Recommended coping strategies include:
- Allowing yourself to grieve. Feelings of guilt, depression, and anger are common.
- Relying on support systems – talk to loved ones, join miscarriage support groups.
- Taking time for self-care like eating well, exercising, meditating, journaling.
- Don’t blame yourself or dwell on what you could have done differently.
- Share your story to help work through emotions and memorialize your loss.
- Focus on the future with hope; many couples later have healthy pregnancies.
- Seek professional counseling if needed to process the loss. Grief can resurface even years later.
- Be patient with the physical and emotional recovery process – healing takes time.
Talk to your healthcare provider right away if you have any signs of depression or deep sadness lasting more than two weeks after the miscarriage occurred.
Frequently Asked Questions
Here are answers to some common questions about miscarriage:
Q: How long does bleeding last after a miscarriage?
Bleeding can last anywhere from a few days to a couple weeks following miscarriage. Contact your doctor if you saturate more than 2 pads per hour.
Q: When can I try to conceive again after a miscarriage?
It is generally recommended to wait at least one normal menstrual cycle to ensure the uterus has healed. Discuss timing with your doctor based on your specific situation.
Q: Does a miscarriage mean I can’t have kids in the future?
No, a single or even multiple miscarriages does not necessarily mean you can’t carry a future pregnancy. Talk to your doctor about prevention based on your history.
Q: Does a miscarriage mean my baby had developmental problems?
Not necessarily. Many miscarriages, especially early ones, occur by chance and the baby may have been perfectly healthy. Testing can sometimes identify any