What does a miscarriage mean?
What Is Miscarriage?
Miscarriage (also called early pregnancy loss) is the death of a baby before the 20th week (or roughly four and a half months) of pregnancy. Having a miscarriage can be devastating and usually takes someone by surprise, even though it's actually quite common. In fact, of known pregnancies, it's estimated that 10% to 15% end in miscarriage, most often before 13 weeks gestation.
Not all miscarriages present the same way. Whether or not you have any symptoms generally depends on how many weeks pregnant you are and the timing of the diagnosis. Generally, the farther along in pregnancy, the more symptoms you will experience. It's also possible that you may not have any symptoms at all.
Typical miscarriage symptoms may include the following:
- Abdominal pain and/or cramping
- Back pain
- Fluid and/or tissue discharge from the vagina
- Loss of pregnancy symptoms, such as nausea and breast tenderness
- Vaginal bleeding (this can range from spotting to heavy bleeding)
As noted above, most miscarriages happen during the first trimester, prior to 13 weeks pregnant. Fortunately, your risk of miscarriage significantly decreases the farther along you are in pregnancy.
What to Do If You Think You're Having a Miscarriage
If you suspect you are having a miscarriage, contact your medical provider. It is important to tell them about any vaginal bleeding that happens when you are pregnant. You may have light staining or spotting of dark red, pink, or bright red blood. If your bleeding is very heavy and combined with strong menstrual cramping, it is more likely that you are having a miscarriage than if it is light and pain-free.
Your doctor will likely do an exam and/or some testing (often ultrasound) to be sure that everything is OK with your pregnancy or to confirm pregnancy loss.
However, if you are less than five months pregnant and you are having some vaginal bleeding, don't panic. Not all bleeding in early pregnancy means you are having a miscarriage. In addition to possible pregnancy loss, your doctor will rule out other reasons for vaginal bleeding, such as:
Implantation Bleeding
You may have some bleeding in early pregnancy from the normal process of the embryo attaching to the wall of your uterus. This is called implantation bleeding. It is usually light bleeding and may be associated with mild cramping.
What Is Implantation Bleeding?
Subchorionic Hemorrhage
Sometimes, implantation bleeding can collect under the placenta and cause a collection or clot of blood. This can be seen on ultrasound and is called a subchorionic hemorrhage.
This type of bleeding may be a little heavier than implantation bleeding and you may have some cramping. You may continue to bleed off and on for a few weeks. Usually, the collection of blood will be reabsorbed by your body and the bleeding will stop.
Understanding Subchorionic Hemorrhage
Post-Coital Bleeding
Did you recently have sex and now you are bleeding? If so, it is likely that you are just bleeding from your cervix. When you're pregnant, the surface of your cervix changes in response to your changing hormone levels. This makes your cervix more likely to bleed when it is touched during sex. This type of bleeding is called post-coital bleeding.
Bleeding due to sexual activity is typically bright red and it may be quite heavy. It's not usually associated with uterine cramping.
Spotting in Early Pregnancy
Urinary Tract Infection
Sometimes, light bleeding that you notice only when you wipe yourself after you urinate may be a sign of a urinary tract infection (UTI). UTIs are very common in early pregnancy, and they often don't present with the typical symptoms of frequent and painful urination.
If you are having a miscarriage, you may be wondering if you did something that caused you to lose the pregnancy. This is very unlikely, particularly if your miscarriage occurred before 13 weeks, as the majority of early miscarriages happen because the embryo is not viable (able to survive to term). In fact, about 50% of all early pregnancy losses are due to chromosomal abnormalities.
However, many miscarriages happen due to unknown causes, as well. It is known that some lifestyle choices can increase your risk of miscarriage, such as cigarette smoking and drug use. Other less common causes of miscarriage include:
- Extreme stress
- Infection
- Maternal autoimmune disorders
- Maternal thrombophilia
- Structural problems of the uterus or cervix
An Overview of High-Risk Pregnancy
While there are many factors that increase your odds of pregnancy loss, studies show that miscarriages often happen without the presence of known risk factors—and it's often unknown exactly why one person miscarries while another doesn't. However, what is certain is that your risk of miscarriage increases with your age.
According to the American College of Obstetricians and Gynecologists (ACOG), your age-based risk of miscarriage is as follows:
- 9% to 17% at ages 20-30
- 20% at age 35
- 40% at age 40
- 80% at age 45
In addition to maternal age, other factors that can increase the risk of pregnancy loss include the following:
- A history of two or more previous miscarriages
- Being underweight
- Exposure to toxic chemicals, such as paint thinners
- Hormonal problems, such as polycystic ovary syndrome (also called PCOS)
- Lifestyle behaviors, including smoking, drinking, and using recreational drugs
- Obesity
- Pre-existing health conditions, such as diabetes, lupus, and high blood pressure
Miscarriage Research: Causes vs. Risk Factors
Recurrent Miscarriages
Although first-trimester miscarriages are common, having more than one miscarriage in a row is not. Simply put, you are much more likely to have a successful pregnancy after a miscarriage than you are to have a second miscarriage (or third or more). Conversely, the more miscarriages you have had, the more likely it is that you will have another one—but the rates are still low.
Recurrent miscarriage is typically defined as three or more consecutive first-trimester pregnancy losses. Studies suggest that this happens in 2% to 5% of pregnant women, with rates increasing with maternal age and the number of miscarriages. But even if you have had more than three miscarriages in a row, it is still more likely that your next pregnancy will continue to term.
Around 75% of women impacted by recurrent miscarriage will go on to successfully carry a pregnancy to term.
Treating Recurrent Miscarriage With hCG Injections
If a miscarriage is diagnosed, you will need treatment to be sure all the products of conception are removed from the uterus. Depending on how far along in pregnancy you are and how much you are bleeding, you may have some choices on how to manage your miscarriage.
If you are bleeding very heavily and you haven't passed all of the pregnancy tissue, you will likely need an emergency dilation and curettage (D&C) procedure to clean out your uterus and stop the bleeding. If you are stable when you are diagnosed, your doctor will likely discuss the following treatment options with you.
Expectant Management
Expectant management means choosing no intervention at all and opting to let your body pass the tissue when it is ready. This approach is generally most successful if you are less than eight weeks pregnant and not recommended if you are more than 13 weeks along.
Medical Management
Medical management means taking a medication called misoprostol that will cause your uterus to pass the tissue. The medicine begins working in a few hours, resulting in bleeding from the vagina and cramping, similar to a heavy period. Vaginal bleeding may persist for a few weeks.
Using Medication to Manage a Miscarriage
Surgical Management
Surgical management is having the tissue removed by a D&C procedure. If the miscarriage is early enough, your doctor may offer you an in-office aspiration of the tissue in your uterus. Again, expect heavy vaginal bleeding and cramping while your body sheds the uterine lining and embryo.
Pros and Cons of D&C After Miscarriage
Preventing Blood Type Complications
In addition to removing fetal tissue, miscarriage management includes checking your blood type. If you are Rh-negative, your doctor will talk to you about a special injection called RhoGAM, which can prevent a pregnancy complication called hemolytic disease of the newborn that could impact future pregnancies.
Second Trimester Miscarriage
Treatment for pregnancy loss after the first trimester is similar to an earlier miscarriage. However, the farther along in pregnancy a miscarriage occurs, the more likely it is that you will need surgery, as there is more fetal tissue that needs to be safely removed from the uterus.
Treatment for Second Trimester Miscarriage
Based on how far along in pregnancy you are and your overall clinical condition, your doctor may suggest one treatment option over the others. Additionally, you may need follow-up care to ensure all of the tissue has passed.
Return of Menstruation
It typically takes about four weeks for your regular period to resume after pregnancy loss, but it can take as long as six to eight weeks. This delay is because the pregnancy hormone (human chorionic gonadotropin or hCG) has to return to pre-pregnancy levels before ovulation will occur again. Your period will come roughly two weeks after you ovulate.
Menstruation After Miscarriage
Allow yourself to grieve. This can't be overemphasized. Having a miscarriage is very upsetting, and it is important that you give yourself time to recover emotionally from your loss.
Losing a pregnancy is just like any other loss of a loved one. You will have the same emotional reactions, although you may pass through the stages of grieving a bit quicker. Processing your emotions and seeking psychological support can help prevent a significant depressive episode.
Once you have lost a pregnancy, you may find that you are more anxious in your next pregnancy. You may even feel ambivalent about the pregnancy. If you are finding it hard to become emotionally attached to your pregnancy after a miscarriage, it can be helpful to discuss this with your doctor and/or a counselor.
Coping with First Trimester Miscarriage
One of the first questions you might have after a miscarriage is, "When can I try again?" This is a very common question. Some physicians will tell you that you need to wait until you have had three regular cycles before you can try again. For most healthy women, it is probably not necessary to wait that long.
Although there isn't clear data on the optimum time to try to get pregnant after a miscarriage, some newer evidence suggests that there is no reason to delay—and that you might actually be extra fertile in the three months after miscarriage. That being said, most physicians agree you should wait at least a few weeks before having vaginal intercourse after a miscarriage to reduce the risk of infection.
Getting Pregnant After a Miscarriage
Having a miscarriage is heartbreaking. Let yourself grieve. It can help to remember that you're much more likely to have a successful outcome in your next pregnancy than another miscarriage. Discussing treatment options with your doctor and getting emotional support for your loss can help you recover physically and emotionally.
Having a Baby After Pregnancy Loss
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Miscarriage (also called early pregnancy loss) is the death of a baby before the 20th week (or roughly four and a half months) of pregnancy. Having a miscarriage can be devastating and usually takes someone by surprise, even though it's actually quite common. In fact, of known pregnancies, it's estimated that 10% to 15% end in miscarriage, most often before 13 weeks gestation.
Not all miscarriages present the same way. Whether or not you have any symptoms generally depends on how many weeks pregnant you are and the timing of the diagnosis. Generally, the farther along in pregnancy, the more symptoms you will experience. It's also possible that you may not have any symptoms at all.
Typical miscarriage symptoms may include the following:
- Abdominal pain and/or cramping
- Back pain
- Fluid and/or tissue discharge from the vagina
- Loss of pregnancy symptoms, such as nausea and breast tenderness
- Vaginal bleeding (this can range from spotting to heavy bleeding)
As noted above, most miscarriages happen during the first trimester, prior to 13 weeks pregnant. Fortunately, your risk of miscarriage significantly decreases the farther along you are in pregnancy.
What to Do If You Think You're Having a Miscarriage
If you suspect you are having a miscarriage, contact your medical provider. It is important to tell them about any vaginal bleeding that happens when you are pregnant. You may have light staining or spotting of dark red, pink, or bright red blood. If your bleeding is very heavy and combined with strong menstrual cramping, it is more likely that you are having a miscarriage than if it is light and pain-free.
Your doctor will likely do an exam and/or some testing (often ultrasound) to be sure that everything is OK with your pregnancy or to confirm pregnancy loss.
However, if you are less than five months pregnant and you are having some vaginal bleeding, don't panic. Not all bleeding in early pregnancy means you are having a miscarriage. In addition to possible pregnancy loss, your doctor will rule out other reasons for vaginal bleeding, such as:
Implantation Bleeding
You may have some bleeding in early pregnancy from the normal process of the embryo attaching to the wall of your uterus. This is called implantation bleeding. It is usually light bleeding and may be associated with mild cramping.
What Is Implantation Bleeding?
Subchorionic Hemorrhage
Sometimes, implantation bleeding can collect under the placenta and cause a collection or clot of blood. This can be seen on ultrasound and is called a subchorionic hemorrhage.
This type of bleeding may be a little heavier than implantation bleeding and you may have some cramping. You may continue to bleed off and on for a few weeks. Usually, the collection of blood will be reabsorbed by your body and the bleeding will stop.
Understanding Subchorionic Hemorrhage
Post-Coital Bleeding
Did you recently have sex and now you are bleeding? If so, it is likely that you are just bleeding from your cervix. When you're pregnant, the surface of your cervix changes in response to your changing hormone levels. This makes your cervix more likely to bleed when it is touched during sex. This type of bleeding is called post-coital bleeding.
Bleeding due to sexual activity is typically bright red and it may be quite heavy. It's not usually associated with uterine cramping.
Spotting in Early Pregnancy
Urinary Tract Infection
Sometimes, light bleeding that you notice only when you wipe yourself after you urinate may be a sign of a urinary tract infection (UTI). UTIs are very common in early pregnancy, and they often don't present with the typical symptoms of frequent and painful urination.
If you are having a miscarriage, you may be wondering if you did something that caused you to lose the pregnancy. This is very unlikely, particularly if your miscarriage occurred before 13 weeks, as the majority of early miscarriages happen because the embryo is not viable (able to survive to term). In fact, about 50% of all early pregnancy losses are due to chromosomal abnormalities.
However, many miscarriages happen due to unknown causes, as well. It is known that some lifestyle choices can increase your risk of miscarriage, such as cigarette smoking and drug use. Other less common causes of miscarriage include:
- Extreme stress
- Infection
- Maternal autoimmune disorders
- Maternal thrombophilia
- Structural problems of the uterus or cervix
An Overview of High-Risk Pregnancy
While there are many factors that increase your odds of pregnancy loss, studies show that miscarriages often happen without the presence of known risk factors—and it's often unknown exactly why one person miscarries while another doesn't. However, what is certain is that your risk of miscarriage increases with your age.
According to the American College of Obstetricians and Gynecologists (ACOG), your age-based risk of miscarriage is as follows:
- 9% to 17% at ages 20-30
- 20% at age 35
- 40% at age 40
- 80% at age 45
In addition to maternal age, other factors that can increase the risk of pregnancy loss include the following:
- A history of two or more previous miscarriages
- Being underweight
- Exposure to toxic chemicals, such as paint thinners
- Hormonal problems, such as polycystic ovary syndrome (also called PCOS)
- Lifestyle behaviors, including smoking, drinking, and using recreational drugs
- Obesity
- Pre-existing health conditions, such as diabetes, lupus, and high blood pressure
Miscarriage Research: Causes vs. Risk Factors
Recurrent Miscarriages
Although first-trimester miscarriages are common, having more than one miscarriage in a row is not. Simply put, you are much more likely to have a successful pregnancy after a miscarriage than you are to have a second miscarriage (or third or more). Conversely, the more miscarriages you have had, the more likely it is that you will have another one—but the rates are still low.
Recurrent miscarriage is typically defined as three or more consecutive first-trimester pregnancy losses. Studies suggest that this happens in 2% to 5% of pregnant women, with rates increasing with maternal age and the number of miscarriages. But even if you have had more than three miscarriages in a row, it is still more likely that your next pregnancy will continue to term.
Around 75% of women impacted by recurrent miscarriage will go on to successfully carry a pregnancy to term.
Treating Recurrent Miscarriage With hCG Injections
If a miscarriage is diagnosed, you will need treatment to be sure all the products of conception are removed from the uterus. Depending on how far along in pregnancy you are and how much you are bleeding, you may have some choices on how to manage your miscarriage.
If you are bleeding very heavily and you haven't passed all of the pregnancy tissue, you will likely need an emergency dilation and curettage (D&C) procedure to clean out your uterus and stop the bleeding. If you are stable when you are diagnosed, your doctor will likely discuss the following treatment options with you.
Expectant Management
Expectant management means choosing no intervention at all and opting to let your body pass the tissue when it is ready. This approach is generally most successful if you are less than eight weeks pregnant and not recommended if you are more than 13 weeks along.
Medical Management
Medical management means taking a medication called misoprostol that will cause your uterus to pass the tissue. The medicine begins working in a few hours, resulting in bleeding from the vagina and cramping, similar to a heavy period. Vaginal bleeding may persist for a few weeks.
Using Medication to Manage a Miscarriage
Surgical Management
Surgical management is having the tissue removed by a D&C procedure. If the miscarriage is early enough, your doctor may offer you an in-office aspiration of the tissue in your uterus. Again, expect heavy vaginal bleeding and cramping while your body sheds the uterine lining and embryo.
Pros and Cons of D&C After Miscarriage
Preventing Blood Type Complications
In addition to removing fetal tissue, miscarriage management includes checking your blood type. If you are Rh-negative, your doctor will talk to you about a special injection called RhoGAM, which can prevent a pregnancy complication called hemolytic disease of the newborn that could impact future pregnancies.
Second Trimester Miscarriage
Treatment for pregnancy loss after the first trimester is similar to an earlier miscarriage. However, the farther along in pregnancy a miscarriage occurs, the more likely it is that you will need surgery, as there is more fetal tissue that needs to be safely removed from the uterus.
Treatment for Second Trimester Miscarriage
Based on how far along in pregnancy you are and your overall clinical condition, your doctor may suggest one treatment option over the others. Additionally, you may need follow-up care to ensure all of the tissue has passed.
Return of Menstruation
It typically takes about four weeks for your regular period to resume after pregnancy loss, but it can take as long as six to eight weeks. This delay is because the pregnancy hormone (human chorionic gonadotropin or hCG) has to return to pre-pregnancy levels before ovulation will occur again. Your period will come roughly two weeks after you ovulate.
Menstruation After Miscarriage
Allow yourself to grieve. This can't be overemphasized. Having a miscarriage is very upsetting, and it is important that you give yourself time to recover emotionally from your loss.
Losing a pregnancy is just like any other loss of a loved one. You will have the same emotional reactions, although you may pass through the stages of grieving a bit quicker. Processing your emotions and seeking psychological support can help prevent a significant depressive episode.
Once you have lost a pregnancy, you may find that you are more anxious in your next pregnancy. You may even feel ambivalent about the pregnancy. If you are finding it hard to become emotionally attached to your pregnancy after a miscarriage, it can be helpful to discuss this with your doctor and/or a counselor.
Coping with First Trimester Miscarriage
One of the first questions you might have after a miscarriage is, "When can I try again?" This is a very common question. Some physicians will tell you that you need to wait until you have had three regular cycles before you can try again. For most healthy women, it is probably not necessary to wait that long.
Although there isn't clear data on the optimum time to try to get pregnant after a miscarriage, some newer evidence suggests that there is no reason to delay—and that you might actually be extra fertile in the three months after miscarriage. That being said, most physicians agree you should wait at least a few weeks before having vaginal intercourse after a miscarriage to reduce the risk of infection.
Getting Pregnant After a Miscarriage
Having a miscarriage is heartbreaking. Let yourself grieve. It can help to remember that you're much more likely to have a successful outcome in your next pregnancy than another miscarriage. Discussing treatment options with your doctor and getting emotional support for your loss can help you recover physically and emotionally.
Having a Baby After Pregnancy Loss
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