Miscarriage

Condition Basics

What is a miscarriage?

A miscarriage is the loss of a pregnancy during the first 20 weeks. Most happen because the fertilized egg in the uterus doesn't develop normally. Miscarriages are very common. You can even have a miscarriage before you know that you're pregnant.

What causes it?

It may help to know that most miscarriages happen because the fertilized egg in the uterus doesn't develop normally, not because of something you did. A miscarriage isn't caused by stress, exercise, or sex. Often, doctors don't know the cause. The risk of miscarriage is lower after the first 12 weeks of the pregnancy.

What are the symptoms?

Symptoms of a miscarriage include bleeding from the vagina with pain, pelvic cramps, or a persistent, dull ache in your lower back. Blood clots or greyish tissue may pass from the vagina. Some people have no symptoms. One person's physical experience of a miscarriage can be very different from someone else's.

How is it diagnosed?

A miscarriage is diagnosed with:

• An ultrasound. This test helps your doctor see if a pregnancy is growing as expected. It also can find a fetal heartbeat and estimate the age of the fetus.
• A history and physical examination. The doctor will ask about your symptoms.
• A pelvic examination. This test allows the doctor to see if the cervix is opening (dilating) or if there is tissue or blood in the cervical opening or the vagina.
• A blood test. This test 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 see if your pregnancy is still progressing.

You may need a blood test to see if you have Rh-negative blood.

If you've had two or more miscarriages in a row, your doctor can test for possible causes. Tests may include blood tests or a pelvic ultrasound.

How is a miscarriage treated?

There's no treatment to stop a miscarriage. If you're having one, you have options. If you don't have heavy blood loss or signs of infection, you can let it follow its course. If you don't want to wait, you can take medicine to help the tissue pass or have a procedure to remove it.

After a miscarriage, are you at risk for another?

Miscarriage is usually a chance event. Your chances of having a successful pregnancy are good, even if you've had one or two miscarriages. If you would like to try to get pregnant again, it is usually safe whenever you feel ready. Talk with your doctor about any future pregnancy plans.

What Increases Your Risk

Things that may increase your risk of miscarriage include:

• Your age. The risk is higher at age 35 and older.
• A history of miscarriages (two or more).
• Certain bacterial or viral infections during pregnancy.
• A blood-clotting disorder. One example is antiphospholipid antibody syndrome.
• Problems with the structure of the uterus. This includes a uterus with a septum or wall.
• Exposure to dangerous chemicals or certain medicines.
• The father's age. The risk is highest after age 35.
• Using alcohol, cigarettes, or cocaine while pregnant.
• Heavy caffeine use while pregnant.

Symptoms

Symptoms of a miscarriage include:

• Bleeding from the vagina. It may be light or heavy, constant or off-and-on. Sometimes it's hard to know if light bleeding is a sign of miscarriage. But if you have bleeding with pain, the chance of a miscarriage is higher.
• 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 started.
• Blood clots or greyish (fetal) tissue passing from the vagina.
• Not feeling pregnant anymore. Your breasts may feel less tender. You may urinate less often and have less nausea and vomiting.

Not everyone has symptoms with a miscarriage. It's not always easy to tell if it's happening. It often isn't a single event. It may be a chain of events over several days. One person's physical experience of a miscarriage can be very different from someone else's.

Examinations and Tests

A miscarriage is diagnosed with:

• An ultrasound. This test helps your doctor see if a pregnancy is growing as expected. It also can find a fetal heartbeat and estimate the age of the fetus.
• A history and physical examination. The doctor will ask about your symptoms, such as bleeding and cramping.
• A pelvic examination. This test allows the doctor to see if the cervix is opening (dilating) or if there is tissue or blood in the cervical opening or the vagina.
• A blood test. This test 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 see if your pregnancy is still progressing.

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

Repeated miscarriage

If you have two or more miscarriages in a row, your doctor can test for possible causes. Your doctor may:

• Test your blood for antibodies. This checks for antiphospholipid antibody syndrome.
• Check for genetic problems.
• Test hormone levels.
• Use hysteroscopy or pelvic ultrasound. They can check for problems with the structure of the uterus.

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Treatment Overview

There is no treatment that can stop a miscarriage. Many miscarriages pass on their own, but some don't. If you are having a miscarriage, you will have several treatment options. But your options may depend on your stage of pregnancy during miscarriage and your current health. Treatment options may include:

Watchful waiting.

As long as you don't have heavy blood loss, a fever, weakness, or other signs of infection, you can let a miscarriage follow its own course. This period of waiting, called expectant management, allows the miscarriage to end naturally while your doctor watches for and treats any complications.

Medicine.

Mifepristone and misoprostol can be used to help the uterus pass the pregnancy tissue.

A surgical procedure.

Dilation and evacuation or vacuum aspiration clears the uterus of tissue. These procedures offer the quickest treatments for a miscarriage.

If you have an Rh-negative blood type, you will need a shot of Rh immune globulin (WinRho) within 72 hours. This prevents a problem called Rh incompatibility in future pregnancies. Your doctor can do a blood test to see if you are Rh-negative.

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

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Self-Care

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 sanitary pads until you stop bleeding.

  Using pads makes it easier to monitor your bleeding. It's 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 ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) for cramps.
• 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.

• Get support.

  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 would like to try to get pregnant again, it is usually safe whenever you feel ready. If you don't want to get pregnant, ask your doctor about birth control options.

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Coping With Grief

It's 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. It's 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. Your doctor will be able to address your questions and concerns about the miscarriage.

To help you and your family cope with your loss, consider meeting with a support group, reading about the experiences of others, and talking to friends or a counsellor or member of the clergy.

How hard and how long you'll grieve will vary. Most people 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. These include feeling sad and hopeless and losing interest in daily activities. It's important to call your doctor if you have symptoms of depression that last for more than a couple of weeks.

A healthy pregnancy is usually possible after a miscarriage. This is true even after repeated miscarriages. If you'd like to try to get pregnant again, it is usually safe whenever you feel ready. Talk with your doctor about any future pregnancy plans.

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