A pregnancy that ends on its own within the first 20 weeks of gestation is called a miscarriage. Miscarriage symptoms that occur before, or during, can be different for everyone. It is the most common type of pregnancy loss. Studies reveal that anywhere from 10-25% of all clinically recognized pregnancies will end in miscarriage. Chemical pregnancies may account for 50-75% of all miscarriages. This occurs when a pregnancy is lost shortly after implantation, resulting in bleeding that occurs around the time of her expected period. The woman may not realize that she conceived when she experiences a chemical pregnancy.
Warning Signs of Miscarriage
If you experience any or all of these miscarriage symptoms, it is important to contact your health care provider or a medical facility to evaluate if you could be having a miscarriage:
Bleeding may start as light spotting, or it could be heavier and appear as a gush of blood. As the cervix dilates to empty, the bleeding becomes heavier.
The heaviest bleeding is generally over within three to five hours from the time heavy bleeding begins. Lighter bleeding may stop and start over one to two weeks before it completely ends.
The color of the blood can range from pink to red to brown. Red blood is fresh blood that leaves the body quickly. Brown blood, on the other hand, is blood that’s been in the uterus a while. You may see discharge the color of coffee grounds, or near black, during a miscarriage.
Exactly how much bleeding you’ll experience depends on a variety of circumstances, including how far along you are and whether or not your miscarriage is progressing naturally. Let your doctor know if you fill more than two sanitary pads an hour for two or more hours in a row.
Other miscarriage symptoms may include:
- Mild to severe back pain (often worse than normal menstrual cramps)
- Weight loss
- White-pink mucus coming from the vagina
- True contractions (very painful happening every 5-20 minutes)
- Tissue with clot like material passing from the vagina
- A sudden decrease in signs of pregnancy
Most miscarriages occur during the first 13 weeks of pregnancy. Pregnancy can be such an exciting time, but with the great number of miscarriages that occur, it is beneficial to be informed about all potential miscarriage symptoms.
What Causes Miscarriage?
During the first trimester, the most common cause of miscarriage is chromosomal abnormality – meaning that something is not correct with the baby’s chromosomes. Most chromosomal abnormalities are the cause of a damaged egg or sperm cell or are due to a problem at the time that the zygote went through the division process. Chromosomes are tiny structures inside the cells of the body that carry many genes, the basic units of heredity. The reasons for miscarriage are varied, and most often cannot be identified.
Other Causes of Miscarriage Include (but are not limited to):
- Exposure to environmental and workplace hazards such as high levels of radiation or toxic agents
- Hormonal irregularities
- Improper implantation of fertilized egg in the uterine lining
- Maternal age
- Uterine abnormalities
- Incompetent cervix (The cervix begins to widen and open too early, in the middle of pregnancy, without signs of pain or labor.)
- Lifestyle factors such as smoking, drinking alcohol, or using illegal drugs
- Disorders of the immune system including lupus, an autoimmune disease
- Severe kidney disease
- Congenital heart disease
- Diabetes that is not controlled
- Thyroid disease
- Certain medicines, such as the acne drug isotretinoin (Accutane®).
- Severe malnutrition.
- Group B beta strep.
What are the Chances of Having a Miscarriage?
- Women under the age of 35 yrs old have about a 15% chance of miscarriage
- An increase in maternal age affects the chances of miscarriage
- Women who are 35-45 yrs old have a 20-35% chance of miscarriage,
- Women over the age of 45 can have up to a 50% chance of miscarriage
- A woman who has had a previous miscarriage has a 25% chance of having another (only a slightly elevated risk than for someone who has not had a previous miscarriage)
Types of Miscarriage
Miscarriage is often a process and not a single event. There are several types of miscarriages and they all may have different miscarriage symptoms. You may hear your health care provider mention types of miscarriages:
- Threatened Miscarriage: Some degree of early pregnancy uterine bleeding accompanied by cramping or lower backache. The cervix remains closed. This bleeding is often the result of implantation.
- Inevitable or Incomplete Miscarriage: Abdominal or back pain accompanied by bleeding with an open cervix. Miscarriage is inevitable when there is a dilation or effacement of the cervix and/or there is a rupture of the membranes. Bleeding and cramps may persist if the miscarriage is not complete.
- Complete Miscarriage: A completed miscarriage is when the embryo or products of conception have emptied out of the uterus. Bleeding should subside quickly, as should any pain or cramping. A completed miscarriage can be confirmed by an ultrasound or by having a surgical curettage (D&C) performed.
- Missed Miscarriage: Women can experience a miscarriage without knowing it. A missed miscarriage is when embryonic death has occurred but there is not any expulsion of the embryo. It is not known why this occurs. Signs of this would be a loss of pregnancy symptoms and the absence of fetal heart tones found on an ultrasound.
- Recurrent Miscarriage (RM): Defined as 3 or more consecutive first trimester miscarriages. This can affect 1% of couples trying to conceive.
- Blighted Ovum: Also called an embryonic pregnancy. A fertilized egg implants into the uterine wall, but fetal development never begins. Often there is a gestational sac with or without a yolk sac, but there is an absence of fetal growth.
- Ectopic Pregnancy: A fertilized egg implants itself in places other than the uterus, most commonly the fallopian tube. Treatment is needed immediately to stop the development of the implanted egg. If not treated rapidly, this could end in serious maternal complications.
- Molar Pregnancy: The result of a genetic error during the fertilization process that leads to the growth of abnormal tissue within the uterus. Molar pregnancies rarely involve a developing embryo, but often entail the most common symptoms of pregnancy including a missed period, positive pregnancy test and severe nausea.
Understanding early fetal development and first-trimester development can give you a good idea of what is going on with your pregnancy, and help you know what your health care provider is looking for when there is a possible miscarriage occurring.
Miscarriage Treatments Options
The main goal of treatment during or after a miscarriage is to prevent hemorrhaging and infection. The earlier you are in the pregnancy, the more likely that your body will expel all the fetal tissue by itself and will not require further medical procedures.
If the body does not expel all the tissue, the most common procedure performed to stop bleeding and prevent infection is a dilation and curettage, known as a D&C. Drugs may be prescribed to help control bleeding after the D&C is performed. Bleeding should be monitored closely once you are at home; if you notice an increase in bleeding or the onset of chills or fever, it is best to call your physician immediately.
Since the cause of most miscarriages is due to chromosomal abnormalities, there is not much that can be done to prevent them. One vital step is to get as healthy as you can before conceiving to provide a healthy atmosphere for conception to occur.
- Exercise regularly
- Eat healthily
- Manage stress
- Keep weight within healthy limits
- Take folic acid daily
- Do not smoke
Once you find out that you are pregnant, the goal is to be as healthy as possible, to provide a healthy environment for your baby to grow in:
- Keep your abdomen safe
- Do not smoke or be around smoke
- Do not drink alcohol
- Check with your doctor before taking any over-the-counter medications
- Limit or eliminate caffeine
- Avoid environmental hazards such as radiation, infectious disease, and x-rays
- Avoid contact sports or activities that have a risk of injury
Emotional Treatment for a Miscarriage
Unfortunately, miscarriage can affect anyone. Women are often left with unanswered questions regarding their physical recovery, their emotional recovery and trying to conceive again. It is very important to keep the lines of communication open with family, friends and health care providers during this time.
Some helpful websites that address miscarriage and pregnancy loss include:
Compiled using information from the following sources:
1. Current Obstetric & Gynecologic Diagnosis & Treatment Ninth Ed. DeCherney, Alan H., et al, Ch. 14.
MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2006 Feb 23]. Pregnancy Loss; [updated 2006 Feb 22; reviewed 2006 Feb 7; cited 2006 Feb 23].
2. Planning Your Pregnancy and Birth Third Ed. The American College of Obstetricians and Gynecologists, Ch. 15.
Williams Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 9