Miscarriage (Pregnancy Loss)

A miscarriage is when a pregnancy ends on its own before 20 weeks. Most miscarriages happen in the first trimester (before 12 weeks). They often happen because of problems with the chromosomes that stop the pregnancy from developing normally.

A miscarriage is not your fault. Nothing you did or didn’t do caused it. About 1 in 10 known pregnancies end in miscarriage.

Losing a pregnancy is deeply personal. It’s OK to take time and need support to process a miscarriage.

What are the first signs of a miscarriage?

Sometimes, there aren’t any signs or symptoms. You may only find out during an ultrasound.

When signs or symptoms of miscarriage do happen, the most common ones are:

• Vaginal bleeding, which may start light and become heavier — including possibly passing tissue or blood clots
• Cramping or pain in your lower belly, stronger than a period
• Low back pain that ranges from mild to severe

Contact your pregnancy care provider right away if you have any of these symptoms. They’ll tell you whether to come to the office or go to the emergency room.

Miscarriage causes

Chromosomal disorders cause about half of all miscarriages. These issues happen with the egg and sperm before fertilization occurs. This can lead to missing, extra or damaged chromosomes that prevent the pregnancy from growing.

Sometimes, other health conditions can raise the risk of miscarriage, like:

• Hormonal imbalances
• Infection
• Problems with your uterus or cervix
• Thyroid disease
• Unmanaged diabetes
• Blood clotting disorders

There isn’t any scientific proof that stress, exercise, sex or birth control pills cause miscarriage. Whatever your situation, please don’t blame yourself.

How long does a miscarriage last?

Everyone’s experience is a little different. Bleeding is usually heaviest at first and then slowly gets lighter. Some people may have spotting for up to three or four weeks.

Cramps often feel like strong period pain. Like the bleeding, they should ease after a few days. You can take over-the-counter pain medication. Ibuprofen works best for cramping, but you can take acetaminophen if you’re unable to take ibuprofen or need additional pain medication. You should reach out to your provider if these medications aren’t helping.

Complications

Most miscarriages don’t cause serious problems. But if complications happen, they may include:

• Heavy bleeding
• Infection

Call your provider if:

• Bleeding gets worse or starts again after stopping
• You pass large clots (bigger than a golf ball)
• Pelvic pain is severe or lasts more than a week
• You feel dizzy, weak or have a racing heartbeat

Risk factors

Risk factors for miscarriage are:

• Age: Studies show that the risk is 9% to 17% for women in their 20s, and rises to 40% by age 40.
• Previous miscarriage: Having one can slightly raise your risk.
• Lifestyle factors: Smoking, drinking alcohol or using recreational drugs increases risk.
• Weight: Having obesity or underweight can play a role.

What is my risk by week?

Your risk of miscarriage goes down with each week of pregnancy. The risk of pregnancy loss in the first trimester is about 1 in 10. In the second trimester, the risk is lower — around 1 in 100.

How is a miscarriage diagnosed?

Your provider may do a few tests to check your pregnancy:

• Ultrasound: The primary way that pregnancy loss is confirmed is with ultrasound. This shows whether there’s an embryo or heartbeat. If these are missing, it may mean the pregnancy has stopped developing. It may be necessary to repeat your ultrasound to see if the pregnancy is developing.
• Blood tests: These check for a hormone called hCG. If your levels are falling, it may mean a pregnancy loss is likely. But usually, an ultrasound is necessary to confirm the loss.

Types of miscarriage

Your pregnancy care provider may use certain terms to describe what’s happening. These include:

• Missed miscarriage: The pregnancy has ended, but you don’t have any symptoms. An ultrasound shows the pregnancy isn’t developing.
• Complete miscarriage: All the pregnancy tissue has passed from your uterus.
• Incomplete miscarriage: Some pregnancy tissue is still in your uterus.
• Inevitable miscarriage: You’re bleeding and cramping, and your cervix has started to open. A miscarriage is likely.
• Threatened miscarriage: You’re bleeding, but your cervix is still closed. Your pregnancy care provider will monitor you closely.

What are the treatments for a miscarriage?

After a miscarriage, your body needs to pass all the pregnancy tissue. If any remaining tissue stays in your uterus, it can cause bleeding or infection.

Sometimes, your body passes everything on its own. If that happens, you may not need treatment. Your provider will do an ultrasound to make sure your uterus is clear.

If your body doesn’t pass everything, or if you haven’t started bleeding, your provider may offer medication or a procedure to help remove the remaining tissue.

Nonsurgical treatment

You can wait to see if you pass the tissue on your own. This can take anywhere from several days up to a couple months. Providers usually recommend medication or a procedure if you have not passed the pregnancy in eight weeks.

If you want to move things along, you can use medication. This helps your uterus pass the tissue. The medications used are usually mifepristone and misoprostol.

These options are typically only available if you’ve miscarried before 12 weeks of pregnancy.

Surgical treatment

Your provider may recommend a procedure if:

• You’re more than 12 weeks pregnant.
• You’re bleeding heavily.
• You have low blood counts (anemia) or a condition that makes you bleed easily.

You can also choose to have a procedure if you do not want to pass the pregnancy at home.

Your provider may do a D&C (dilation and curettage) in the first trimester or a D&E (dilation and evacuation) in the second trimester. In both, they open your cervix and gently remove the tissue from your uterus.

A D&C can be done in the office with numbing medication, anxiety medication or light sedation or in the operating room with anesthesia. A D&E is done in the operating room with anesthesia.

What are some of the symptoms after a miscarriage?

Bleeding and mild discomfort are common symptoms after a miscarriage. You can take over-the-counter pain medications for pain, like ibuprofen and acetaminophen.

Use only pads while you’re still bleeding — not tampons.

Don’t put anything inside your vagina or have intercourse for at least two weeks. This includes tampons, fingers or sex toys. Your provider will schedule a follow-up appointment to make sure all the tissue has passed.

Can I get pregnant after I’ve had a miscarriage?

Yes. Most women who have a miscarriage go on to have a healthy pregnancy. Having a miscarriage doesn’t mean you’re infertile or that you’ll have another one.

How soon can I get pregnant after a miscarriage?

You can talk with your provider about the right time to try again. It’s possible for fertility to return as soon as two weeks after a pregnancy loss, before your period has returned. Be sure to talk to your provider about your timeline for trying for another pregnancy or about birth control if you want to prevent pregnancy.

How can I cope with my miscarriage?

Losing a pregnancy can be heartbreaking. You might feel sadness, anger, guilt or confusion — or all of these at once. That’s normal.

Emotional healing can take longer than physical healing. Give yourself time to grieve.

Talk to people you trust — your partner, friends or family. You can also find support groups or speak with a mental health professional. You don’t have to go through this alone.

Can I prevent a miscarriage?

Most miscarriages aren’t preventable — and they’re not your fault.

Taking care of your body is the best thing you can do. Here are some ways to do that:

• Go to all your prenatal appointments.
• Maintain a weight that's healthy for you.
• Avoid alcohol, cigarettes and recreational drugs.
• Take a prenatal vitamin.
• Stay active and eat well.