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Miscarriages

Understanding Miscarriage

Losing a pregnancy can be heartbreaking. And unfortunately, miscarriages are fairly common. On average, about 1 in 5 pregnancies will end in a miscarriage — usually in the first trimester.

In most cases, a miscarriage cannot be prevented because it is the result of a chromosomal abnormality or problem with the development of the fetus. Still, certain factors — such as age, smoking, drinking, and a history of miscarriage — put a woman at a higher risk for losing a pregnancy.

While miscarriages usually cannot be prevented, by taking care of yourself and following your health care provider's recommendations, you can increase the chances that you and your baby will be healthy throughout the pregnancy.

What Is a Miscarriage?

A miscarriage is the spontaneous abortion of an embryo or fetus before it's developed enough to survive. This often happens even before a woman is aware that she is pregnant.

A miscarriage usually occurs in the first 3 months of pregnancy, before 12 weeks' gestation. A small fraction of miscarriages — less than 1% of them — are called stillbirths, as they occur after 20 weeks of gestation.

Symptoms of a Miscarriage

Many women don't even know that they've had a miscarriage (since they hadn’t known they were pregnant), thinking that it's just a particularly heavy menstrual flow.

Some women experience cramping, spotting, heavier bleeding, abdominal pain, pelvic pain, weakness, or back pain. Spotting is often not a sign of a miscarriage; many women experience it early on in pregnancy. But just to be safe, if you have spotting or any of these other symptoms anytime during your pregnancy, talk with your doctor.

Types of Miscarriage

If you think you may have had a miscarriage, your doctor may use a number of terms to explain what has happened:

Stillbirths

A stillbirth, which many experts define as the death of a baby after the 20th week of pregnancy, can occur before delivery or during labor or delivery. It is rare and occurs in less than 1% of all births. A stillbirth also is sometimes referred to as intrauterine fetal death or antenatal death.

While there are some known risk factors for stillbirth (such as smoking, problems with the placenta, a pregnancy lasting longer than 42 weeks, and some infections), there is no way to predict when stillbirth will happen or who will have one, and the cause of many stillbirths remains unknown.

The first and most common sign of a stillbirth is decreased movement in the baby. Other possible signs include persistent cramping or stabbing pains in the pelvis, back, or lower abdomen, or vaginal bleeding. If you experience any of these symptoms, call your doctor immediately.

Your doctor can use an ultrasound to detect the heartbeat or give you an electronic fetal non-stress test, which involves lying on your back with electronic monitors attached to your abdomen. The monitors record the baby's heart rate, movements, and contractions of the uterus.

Why Do Miscarriages Happen?

The most common cause of pregnancy loss is a problem with the chromosomes that would make it impossible for the fetus to develop normally.

Other factors that could contribute to a miscarriage include:

Certain behaviors also increase the risk of a miscarriage. Smoking, for example, puts nicotine and other chemicals into the bloodstream, causes the fetus to get less oxygen, and increases the chance of losing a pregnancy. Alcohol and illegal drugs can also lead to miscarriages.

After a Miscarriage

If you have miscarried, your doctor will do a pelvic exam and an ultrasound to confirm the miscarriage. If the uterus is clear of any fetal tissue, or it is very early in the pregnancy, then there often won't be any more treatment.

But if the uterus still contains the fetus or other tissues from the pregnancy, this will need to be removed. The doctor may give you medicine to help pass the tissue or may need to dilate the cervix to perform a dilation and curettage (or D&C, which is a scraping of the uterine lining) or a dilation and extraction (or D&E, which is a suction of the uterus to remove fetal or placental tissue). You may have bleeding or cramping after these procedures, which are done with anesthesia.

If it is determined that your baby has died later in pregnancy, the doctor might decide to induce labor and delivery. After the delivery, the doctor will have the baby and the placenta examined to help determine the cause of death if it's still unknown.

If you've had several miscarriages, you may want to be evaluated to see if any anatomic, genetic, or hormonal abnormalities are contributing to the miscarriages.

Can Miscarriages Be Prevented?

Although miscarriages usually can't be prevented, you can take precautions to increase your chances of having a healthy pregnancy:

Trying Again

If you've had a miscarriage, it's important to take time to grieve. The loss of a baby during pregnancy is like the loss of any loved one. Give yourself time to heal emotionally and physically. Some health care providers recommend that women wait one menstrual cycle or more before trying to get pregnant again to give their bodies and psyches time to heal.

Some other things that can help you get through this difficult time:

Reviewed by: Larissa Hirsch, MD
Date reviewed: January 2012

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Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.
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