Miscarriage

Topic Overview

Is this topic for you?

This topic is about the loss of a baby before 20 weeks of pregnancy. For information about the loss of a baby after 20 weeks of pregnancy but before the baby is born, see the topic Stillbirth.

What is a miscarriage?

A miscarriage is the loss of a pregnancy during the first 20 weeks. It is usually your body's way of ending a pregnancy that has had a bad start. The loss of a pregnancy can be very hard to accept. You may wonder why it happened or blame yourself. But a miscarriage is no one's fault, and you can't prevent it.

Miscarriages are very common. For women who already know they are pregnant, about 1 out of 6 have a miscarriage.^{footnote 1} It is also common for a woman to have a miscarriage before she even knows that she is pregnant.

What causes a miscarriage?

Most miscarriages happen because the fertilized egg in the uterus does not develop normally. A miscarriage is not caused by stress, exercise, or sex. In many cases, doctors don't know what caused the miscarriage.

The risk of miscarriage is lower after the first 12 weeks of the pregnancy.

What are the common symptoms?

Common signs of a miscarriage include:

Bleeding from the vagina. The bleeding may be light or heavy, constant or off and on. It can sometimes be hard to know whether light bleeding is a sign of miscarriage. But if you have bleeding with pain, the chance of a miscarriage is higher.
Pain in the belly, lower back, or pelvis.
Tissue that passes from the vagina.

How is a miscarriage diagnosed?

Call your doctor if you think you are having a miscarriage. If your symptoms and a pelvic examination do not show whether you are having a miscarriage, your doctor can do tests to see if you are still pregnant.

How is it treated?

No treatment can stop a miscarriage. As long as you do not have heavy blood loss, a fever, weakness, or other signs of infection, you can let a miscarriage follow its own course. This can take several days.

If you have Rh-negative blood, you will need a shot of WinRho within 72 hours. This prevents problems in future pregnancies. If you have not had your blood type checked, you will need a blood test to find out if you are Rh-negative.

Many miscarriages complete on their own. But sometimes treatment is needed. If you are having a miscarriage, work with your doctor to watch for and prevent problems. If the uterus does not clear quickly enough, you could lose too much blood or develop an infection. In this case, medicine or a procedure called a dilation and curettage (D&C) can more quickly clear tissue from the uterus.

A miscarriage doesn't happen all at once. It usually takes place over several days, and symptoms vary. Here are some tips for dealing with a miscarriage:

Use pads instead of tampons. It is normal to have mild or moderate vaginal bleeding for 1 to 2 weeks. It may be similar to or slightly heavier than a normal period. The bleeding should get lighter after a week. You may use tampons during your next period, which should start in 3 to 6 weeks.
Take acetaminophen (Tylenol) for cramps. Read and follow all instructions on the label. You may have cramps for several days after the miscarriage.
Eat a balanced diet that is high in iron and vitamin C. You may be low in iron because of blood loss. Foods rich in iron include red meat, shellfish, eggs, beans, and leafy green vegetables. Foods high in vitamin C include citrus fruits, tomatoes, and broccoli. Talk to your doctor about whether you need to take iron pills or a multivitamin.
Talk with family, friends, or a counsellor if you are having trouble dealing with the loss of your pregnancy. If you feel very sad or depressed for longer than a couple of weeks, talk to a counsellor or your doctor.
Talk with your doctor about any future pregnancy plans. If you don't want to get pregnant, ask your doctor about birth control options.

After a miscarriage, are you at risk for miscarrying again?

Miscarriage is usually a chance event, not a sign of an ongoing problem. If you have had one miscarriage, your chances for future successful pregnancies are good. It is unusual to have three or more miscarriages in a row. But if you do, your doctor may do tests to see if a health problem may be causing the miscarriages.

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Miscarriage: Should I Have Treatment to Complete a Miscarriage?

Symptoms

Symptoms of a miscarriage include:

Vaginal bleeding that may be light or heavy, constant or irregular. Although bleeding is often the first sign of a miscarriage, first-trimester bleeding may also occur with a normal pregnancy. But bleeding with pain is a sign that miscarriage is more likely.
Pain. You may have pelvic cramps, belly pain, or a persistent, dull ache in your lower back. Pain may start a few hours to several days after bleeding has begun.
Blood clots or grayish (fetal) tissue passing from the vagina.

It is not always easy to tell whether a miscarriage is taking place. A miscarriage often does not occur as a single event but as a chain of events over several days. One woman's physical experience of a miscarriage can be very different from another woman's experience.

Risk factors for miscarriage

Things that may increase your risk of miscarriage include:

Your age, especially at age 35 and older.
A history of recurrent miscarriage (three or more).
Polycystic ovary syndrome, which can cause ovulation problems, obesity, increased male hormone levels, and an increased risk of diabetes.
Certain bacterial or viral infections during pregnancy.
A blood-clotting disorder such as antiphospholipid antibody syndrome.
Problems with the structure of the uterus (such as a uterus with a septum or wall).
Exposure to dangerous chemicals or certain medicines.
The father's age, especially after age 35.
Alcohol use, cigarette smoking, or cocaine use during pregnancy.
Heavy caffeine use during pregnancy.

It is normal to wonder whether you did something to cause your miscarriage. It may help to know that most miscarriages happen because the fertilized egg in the uterus does not develop normally, not because of something you did. A miscarriage is not caused by stress, exercise, or sex.

Examinations and Tests

A miscarriage is diagnosed with:

A pelvic examination, which allows the doctor to see whether the cervix is opening (dilating) or whether there is tissue or blood in the cervical opening or the vagina.
A blood test, which checks the level of the pregnancy hormone called human chorionic gonadotropin (hCG). Your doctor may take several measurements of hCG levels over a period of days to learn whether your pregnancy is still progressing.
An ultrasound, which helps your doctor find out whether the amniotic sac is intact, detect a fetal heartbeat, and estimate the age of the fetus.

If you have not had a blood test before, you may have one to see if you have Rh-negative blood.

Recurrent miscarriage. If you have three or more miscarriages, your doctor can test for possible causes, including:

Testing your blood for antibodies to check for antiphospholipid antibody syndrome.
Checking for genetic problems.
Testing hormone levels to check for polycystic ovary syndrome.
Using hysteroscopy or pelvic ultrasound to check for problems with uterine structure.

Treatment Overview

There is no treatment that can stop a miscarriage. As long as you do not have heavy blood loss, fever, weakness, or other signs of infection, you can let a miscarriage follow its own course. This can take several days.

If you have an Rh-negative blood type, you will need a shot of low-dose WinRho. This prevents problems in future pregnancies. Your doctor can do a blood test to see if you are Rh-negative.

If a miscarriage is causing intense pain or bleeding or is taking longer than you are comfortable with, talk to your doctor about using medicine or surgery (such as a procedure called dilation and curettage, or D&C) to clear the uterus.

A family doctor, obstetrician, or midwife can manage a miscarriage.

Miscarriage: Should I Have Treatment to Complete a Miscarriage?

Threatened miscarriage

If you have vaginal bleeding but tests suggest that your pregnancy is still progressing, your doctor may recommend:

Resting. You may be advised to temporarily avoid sexual intercourse (pelvic rest) and heavy activity. Your doctor may recommend bedrest. But no research has shown that these treatments prevent miscarriage.^{footnote 2}
Taking progesterone. Your doctor may suggest treatment with progesterone. Research shows it might be helpful for some women.^{footnote 2}
Avoiding NSAIDs. You may be advised to avoid aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Use only acetaminophen, such as Tylenol, for non-prescription pain relief.

No treatment has been shown to stop miscarriage. If you had a miscarriage, there was nothing you could have done to prevent it.

Incomplete miscarriage

Sometimes all or some of the fetal tissue stays in the uterus after a pregnancy miscarries. This is called an incomplete miscarriage (incomplete or missed spontaneous abortion). If your doctor determines that you have had an incomplete miscarriage, you will have one or more treatment options:

Watchful waiting. This period of waiting, called expectant management, allows the miscarriage to end naturally while your doctor watches for and treats any complications.
Medicine. Using misoprostol causes the uterus to empty.
Dilation and curettage (D&C).
Dilation and curettage or vacuum aspiration clears the uterus of tissue. These surgeries offer the quickest treatments for a miscarriage.

Miscarriage: Should I Have Treatment to Complete a Miscarriage?

Additional treatment concerns

If you are bleeding heavily, you will be tested for anemia and treated if needed.

In very rare cases, removal of the uterus (hysterectomy) is needed for women who have severe, uncontrollable bleeding or a severe infection that is not cured with antibiotics.

After a miscarriage

If you plan to become pregnant again, check with your doctor.

Your chances of having a successful pregnancy are good, even if you've had one or two miscarriages.

If you have had three or more miscarriages (recurrent miscarriage), your doctor may suggest further testing to help find the cause.

Home Treatment

There is nothing you can do to prevent a miscarriage. It is usually the body's way of ending a pregnancy that has had a bad start, often at the earliest stage of cell division.

It is important to be alert to the symptoms of a miscarriage so that you can seek medical evaluation. If you are having symptoms of a miscarriage, avoid sexual activity (called pelvic rest) and strenuous activity until your symptoms have been evaluated by a doctor or midwife.

Call
911 anytime you think you may need emergency care. For example, call if:

You have sudden, severe pain in your belly or pelvis.
You passed out (lost consciousness).
You have severe vaginal bleeding.

Call your doctor or midwife now or seek immediate medical care if:

You are dizzy or light-headed, or you feel like you may faint.
You have new or increased pain in your belly or pelvis.
Your vaginal bleeding is getting worse.
You have increased pain in the vaginal area.
You have a fever.

Watch closely for changes in your health, and be sure to contact your doctor or midwife if:

You have new or worse vaginal discharge.
You do not get better as expected.

Coping with a miscarriage

It is normal to go through a grieving process after a miscarriage, regardless of the length of your pregnancy. Guilt, anxiety, and sadness are common and normal reactions after a miscarriage. It is also normal to want to know why a miscarriage has happened. In most cases a miscarriage is a natural event that could not have been prevented.

To help you and your family cope with your loss, consider meeting with a support group, reading about the experiences of other mothers, and talking to friends or a counsellor or member of the clergy. For more information, see the topic Grief and Grieving.

Your local bookstore or library may have books on coping with miscarriage. Also, your doctor or midwife will be able to address your questions and concerns about the miscarriage.

The intensity and duration of the grief varies from woman to woman. But most women find that they can return to the daily demands of life in a fairly short time. The loss and the hormonal swings that result from a miscarriage can cause symptoms of depression, such as feeling sad and hopeless and losing interest in daily activities. It is important to call your doctor or midwife if you have symptoms of depression that last for more than a couple of weeks.

A healthy pregnancy is possible for most women who have had a miscarriage. This is true even after repeated miscarriages. If you want to become pregnant again, check with your doctor or midwife.

References

Citations

National Institute of Child Health and Human Development (2010). Research on Miscarriage and Stillbirth. Available online: http://www.nichd.nih.gov/womenshealth/research/pregbirth/miscarriage_stillbirth.cfm.

American College of Obstetricians and Gynecologists (2018). Early pregnancy loss. ACOG Practice Bulletin No. 200. Obstetrics and Gynecology, published online August 28, 2018. DOI: 10.1097/AOG.0000000000002899. Accessed September 13, 2018.

Other Works Consulted

American College of Obstetricians and Gynecologists (2011). Antiphospholipid syndrome. ACOG Practice Bulletin No. 118. Obstetrics and Gynecology, 117(1): 192–199.

American College of Obstetricians and Gynecologists (2018). Early pregnancy loss. ACOG Practice Bulletin No. 200. Obstetrics and Gynecology, published online August 28, 2018. DOI: 10.1097/AOG.0000000000002899. Accessed September 13, 2018.

Dempsey A, Davis A (2008). Medical management of early pregnancy failure: How to treat and what to expect. Seminars in Reproductive Medicine, 26(5): 401–410.

National Institute of Child Health and Human Development (2010). Research on Miscarriage and Stillbirth. Available online: http://www.nichd.nih.gov/womenshealth/research/pregbirth/miscarriage_stillbirth.cfm.

Porter TF, et al. (2008). Early pregnancy loss. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 62–70. Philadelphia: Lippincott Williams and Wilkins.

Van Aerde J, et al. (2001, reaffirmed 2012). Guidelines for health care professionals supporting families experiencing a perinatal loss. Paediatrics and Child Health, 6(7): 469–477. Also available online: http://www.cps.ca/en/documents/position/supporting-families-experiencing-perinatal-loss.

Wahabi HA, et al. (2018). Progestogen for treating threatened miscarriage. Cochrane Database of Systematic Reviews, (8). DOI: 10.1002/14651858.CD005943.pub5. Accessed September 7, 2018.