A miscarriage, also called spontaneous abortion, is the
spontaneous ending of a pregnancy before the fetus is mature enough to survive
outside the uterus. About one-third of all pregnancies end in miscarriage, most
often before a woman misses a menstrual period or even knows she is pregnant.
One out of five recognized pregnancies will miscarry.
A miscarriage is most likely to occur within the first three
months of pregnancy, before 12 weeks gestation. Only 1 percent of miscarriages
occur after 20 weeks gestation; these are termed late miscarriages.
What are the symptoms of a miscarriage?
Symptoms of a miscarriage include:
- Bleeding which progresses from light to heavy
- Cramps
- Abdominal pain
- Fever
- Weakness
- Vomiting
- Back pain
If you are experiencing the symptoms listed above, contact your
obstetric health care provider right away. He or she will tell you to come in to
the office or go to the emergency room.
What causes miscarriage?
About half of all miscarriages that occur in the first trimester are caused
by chromosomal abnormalities--which may be hereditary or spontaneous.
Chromosomes are tiny structures inside the cells of the body which carry many
genes, the basic units of heredity.
Genes determine all of a person’s physical attributes, such as
sex, hair and eye color, and blood type. Most chromosomal problems occur by
chance and are not related to the mother’s or father’s health.
Miscarriages are also caused by a variety of unknown and known factors, such as:
- Infection
- Exposure to environmental and workplace hazards such as high levels of
radiation or toxic agents
- Hormonal irregularities
- 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 medications, such as the acne drug Accutane®
- Severe malnutrition
Note: There is no proof that stress or physical or sexual
activity causes miscarriage.
Sometimes, treatment of a mother’s medical condition can improve
the chances for a successful pregnancy.
What are the risk factors for a miscarriage?
A risk factor is a trait or behavior that increases a person’s chance of
developing a disease or predisposes a person to a certain condition. Risk
factors for miscarriage include:
- Previous miscarriage—One does not increase the risk, but two or more
does.
- Maternal age—Studies show that the risk of miscarriage is about 15
percent for women in their 20s and rises to about 40 percent for women at
age 40. Paternal age is not thought to affect the risk.
- Certain health conditions in the mother as listed above in the section,
"What causes miscarriage?"
How is a miscarriage diagnosed and treated?
Your health care provider will perform a pelvic exam and an ultrasound test
to confirm the miscarriage. If the miscarriage is complete and the uterus is
clear, then no further treatment is usually required. Occasionally, the uterus
is not completely emptied, so a dilation and curettage (D&C) or dilation and
extraction (D&E) procedure is performed. During these procedures, the cervix is
dilated, and any remaining fetal or placental tissue is gently scraped or
suctioned out of the uterus. Usually this is performed in an operating room
under anesthesia.
A third option (besides waiting for the tissue to pass or having
a D&C, is to take an oral medication to hasten the process along. In this case,
the tissue will pass at home. A repeat visit to the office is needed to make
sure that the uterus is completely empty.
If the pregnancy looks healthy despite the bleeding, bed rest is
often prescribed for several days. When the bleeding stops, usually you will be
able to continue with your normal activities. This is called "a threatened
abortion."
Blood tests, genetic tests or medication may be necessary if a
woman has more than two miscarriages in a row (called repeated miscarriage).
Some diagnostic tests may include:
- Special blood testing
- Endometrial biopsy
- Hysterosalpingogram (an X-ray of the uterus and fallopian tubes)
- Hysteroscopy (a test in which the doctor views the inside of the uterus
with a thin, telescope-like device)
- Laparoscopy (a procedure in which the doctor views the pelvic organs
with a lighted device)
- Referral to a specialist
What are some of the symptoms after a miscarriage?
Spotting and mild discomfort are common symptoms after a miscarriage. If you
have heavy bleeding, fever, chills, or pain, contact your health care provider
right away. These may be signs of an infection.
Can I get pregnant after I’ve had a miscarriage?
Yes. Most women (87 percent) who have miscarriages have subsequent normal
pregnancies and births. Having a miscarriage does not necessarily mean you have
a fertility problem. But about 1 percent of women may have repeated miscarriages
(three or more). Some researchers believe this is related to an autoimmune response.
Discuss the timing of your next pregnancy with your health care provider.
Some health care providers recommend waiting a certain amount of
time (from one menstrual cycle to 3 months) before trying to conceive again. To
prevent another miscarriage, your health care provider may recommend treatment
with progesterone, a hormone needed for implantation in the uterus.
Taking time to heal both physically and emotionally after a
miscarriage is important. Above all, don’t blame yourself for the miscarriage.
Counseling is available to help you cope with your loss. Pregnancy loss support
groups may also be a valuable resource to you and your partner. Ask your health
care provider for more information about counseling and support groups.
If you’ve had two miscarriages in a row, you should stop trying
to conceive, use a form of birth control, and ask your health care provider to
perform diagnostic tests to determine the cause of the miscarriages.
Can a miscarriage be prevented?
Usually a miscarriage can not be prevented and often occurs because the
pregnancy is not normal.
Sometimes, treatment of a mother’s medical condition can improve the chances for a successful pregnancy.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 1/23/2008...#9688
