26 Aug Miscarriage (Risks, Signs, Symptoms, Tests and Recovery)

Source: March of Dimes

What is miscarriage?

Miscarriage (also called early pregnancy loss) is when a baby dies in the womb (uterus) before 20 weeks of pregnancy. For women who know they’re pregnant, about 10 to 15 in 100 pregnancies (10 to 15 percent) end in miscarriage. Most miscarriages happen in the first trimester before the 12th week of pregnancy. Miscarriage in the second trimester (between 13 and 19 weeks) happens in 1 to 5 in 100 (1 to 5 percent) pregnancies.

As many as half of all pregnancies may end in miscarriage. We don’t know the exact number because a miscarriage may happen before a woman knows she’s pregnant. Most women who miscarry go on to have a healthy pregnancy later.

What are repeat miscarriages?

If you have repeat miscarriages (also called recurrent pregnancy loss), you have two or more miscarriages in a row. About 1 in 100 women (1 percent) have repeat miscarriages. Most women who have repeat miscarriages (50 to 75 in 100 or 75 percent) have an unknown cause. And most women with repeat miscarriages with an unknown cause (65 in 100 women or 65 percent) go on to have a successful pregnancy.

What causes miscarriage and repeat miscarriages?

We don’t know what causes every miscarriage. But some miscarriages and repeat miscarriages can be caused by:

Problems with chromosomes

About half of all miscarriages are caused when an embryo (fertilized egg) gets the wrong number of chromosomes. This usually happens by chance and not from a problem passed from parent to child through genes. Chromosomes are the structures in cells that holds genes. Each person has 23 pairs of chromosomes, or 46 in all. For each pair, you get one chromosome from your mother and one from your father. Examples of chromosome problems that can cause miscarriage include:

• Blighted ovum. This is when an embryo implants in the uterus but doesn’t develop into a baby. If you have a blighted ovum, you may have dark-brown bleeding from the vagina early in pregnancy. If you’ve had signs or symptoms of pregnancy, like sore breasts or nausea(feeling sick to your stomach), you may stop having them.
• Intrauterine fetal demise. This is when an embryo stops developing and dies.
• Molar pregnancy. This is when tissue in the uterus forms into a tumor at the beginning of pregnancy.
• Translocation. This is when part of a chromosome moves to another chromosome. Translocation causes a small number of repeat miscarriages.

Problems with the uterus or cervix.

The cervix is the opening to the uterus that sits at the top of the vagina. Problems with the uterus and cervix that can cause miscarriage include:

• Septate uterus. This is when a band of muscle or tissue (called a septum) divides the uterus in two sections. If you have a septate uterus, your provider may recommend surgery before you try to get pregnant to repair the uterus to help reduce your risk of miscarriage. Septate uterus the most common kind of congenital uterine abnormality. This means it’s a condition that you’re born with that affects the size, shape or structure of the uterus. Septate uterus is a common cause of repeat miscarriages.
• Asherman syndrome. If you have this condition, you have scars or scar tissue in the uterus that can damage the endometrium (the lining of the uterus). Before you get pregnant, your provider may use a procedure called hysteroscopy to find and remove scar tissue. Asherman syndrome may often cause repeat miscarriages that happen before you know you’re pregnant.
• Fibroids (growths) in the uterus or scars from surgery on the uterus. Fibroids and scars can limit space for your baby or interfere with your baby’s blood supply. Before you try to get pregnant, you may need a surgery called myomectomy to remove them.
• Cervical insufficiency (also called incompetent cervix). This is when your cervix opens (dilates) too early during pregnancy, usually without pain or contractions. Contractions are when the muscles of your uterus get tight and then relax to help push your baby out during labor and birth. Cervical insufficiency may lead to miscarriage, usually in the second trimester. To help prevent this, your provider may recommend cerclage. This is a stitch your provider puts in your cervix to help keep it closed.

Infections

Infections, like sexually transmitted infections (also called STIs) and listeriosis, can cause miscarriage. An STI, like genital herpes and syphilis, is an infection you can get from having sex with someone who is infected. If you think you may have an STI, tell your health care provider right away. Early testing and treatment can help protect you and your baby. Listeriosis is a kind of food poisoning. If you think you have listeriosis, call your provider right away. Your provider may treat you with antibiotics to help keep you and your baby safe. Having certain infections may cause miscarriage, but they’re not likely to cause repeat miscarriages.

Are you at risk for a miscarriage?

Some things may make you more likely than other woman to have a miscarriage. These are called risk factors. Risk factors for miscarriage include:

• Having two or more previous miscarriages
• Being 35 or older. As you get older, your risk of having a miscarriage increases.
• Smoking, drinking alcohol or using harmful drugs. If you’re pregnant or thinking about getting pregnant and need help to quit, tell your provider.
• Being exposed to harmful chemicals. You or your partner having contact with harmful chemicals, like solvents, may increase your risk of miscarriage. A solvent is a chemical that dissolves other substances, like paint thinner. Talk to your provider about what you can do to protect yourself and your baby.

Some health conditions may increase your risk for miscarriage. Treatment of these conditions before and during pregnancy can sometimes help prevent miscarriage and repeat miscarriages. If you have any of these health conditions, tell your health care provider before you get pregnant or as soon as you know you’re pregnant:

• Autoimmune disorders. These are health conditions that happen when antibodies (cells in the body that fight off infections) attack healthy tissue by mistake. Autoimmune disorders that may increase your risk of miscarriage include antiphospholipid syndrome (also called APS) and lupus (also called systemic lupus erythematosus or SLE). If you have APS, your body makes antibodies that attack certain fats that line the blood vessels; this can sometimes cause blood clots. If you have APS and have had repeat miscarriages, your provider may give you low-dose aspirin and a medicine called heparin during pregnancy and for a few weeks after you give birth to help prevent another miscarriage. Lupus can cause swelling, pain and sometimes organ damage. It can affect your joints, skin, kidneys, lungs and blood vessels. If you have lupus, your provider may treat you with low-dose aspirin and heparin during pregnancy.
• Obesity. This means you have too much body fat and your body mass index (also called BMI) is 30 or higher. BMI is a measure of body fat based on your height and weight. If you’re obese, your chances of having a miscarriage may increase. To find out your BMI, go to cdc.gov/bmi.
• Hormone problems, like polycystic ovary syndrome (also called PCOS) and luteal phase defect. Hormones are chemicals made by the body. PCOS happens when you have hormone problems and cysts on the ovaries. A cyst is a closed pocket of that contains air, fluid or semi-solid substances. If you’re trying to get pregnant, your provider may give you medicine to help you ovulate (release an egg from your ovary into the fallopian tubes). Luteal phase defect can cause repeat miscarriages. It’s when you have low levels of progesterone over several menstrual cycles. Progesterone is a hormone that helps regulate your periods and gets your body ready for pregnancy. If you have luteal phase defect, your provider may recommend treatment with progesterone before and during pregnancy to help prevent repeat miscarriages.
• Preexisting diabetes (also called type 1 or type 2 diabetes). Diabetes is when you have too much sugar (also called glucose) in your blood. Preexisting diabetes means you have diabetes before you get pregnant.
• Thyroid problems, including hypothyroidism and hyperthyroidism. They thyroid is a butterfly-shaped gland in your neck. Hypothyroidism is when the thyroid gland doesn’t make enough thyroid hormones. Hyperthyroidism is when the thyroid gland makes too many thyroid hormones.
• Having certain prenatal tests, like amniocentesis and chorionic villus sampling. These tests have a slight risk of miscarriage. Your provider may recommend them if your baby is at risk for certain genetic conditions, like Down syndrome.

 

Having an injury to your belly, like from falling down or getting hit, isn’t a high risk for miscarriage. Your body does a good job of protecting your baby in the early weeks of pregnancy.

You may have heard that getting too much caffeine during pregnancy can increase your risk for miscarriage. Caffeine is a drug found in foods, drinks, chocolate and some medicine. It’s a stimulant, which means it can help keep you awake. Some studies say caffeine may cause miscarriage, and some say it doesn’t. Until we know more about how caffeine can affect pregnancy, it’s best to limit the amount you get to 200 milligrams each day. This is what’s in about one 12-ounce cup of coffee.

What are the signs and symptoms of miscarriage?

Signs of a condition are things someone else can see or know about you, like you have a rash or you’re coughing. Symptoms are things you feel yourself that others can’t see, like having a sore throat or feeling dizzy.

Signs and symptoms of miscarriage include:

• Bleeding from the vagina or spotting
• Cramps like you feel with your period
• Severe belly pain

If you have any of these signs or symptoms, call your provider. Your provider may want to do some tests to make sure everything’s OK. These tests can include blood tests, a pelvic exam and an ultrasound. An ultrasound is a test that uses sound waves and a computer screen to show a picture of your baby inside the womb.

Many women have these signs and symptoms in early pregnancy and don’t miscarry.

What treatment do you get after a miscarriage or repeat miscarriages?

If you’ve had a miscarriage, your provider may recommend:

• Dilation and curettage (also called D&C). This is a procedure to remove any remaining tissue from the uterus. Your provider dilates (widens) your cervix and removes the tissue with suction or with an instrument called a curette.
• Medicine. Your provider may recommend medicine that can help your body pass tissue that’s still in the uterus.

Do you need any medical tests after a miscarriage or repeat miscarriages?

If you miscarry in your first trimester, you probably don’t need any medical tests. Because we don’t often know what causes a miscarriage in the first trimester, tests may not be helpful in trying to find out a cause.

If you have repeat miscarriages in the first trimester, or if you have a miscarriage in the second trimester, your provider usually recommends tests to help find out the cause. Tests can include:

• Chromosome tests. You and your partner can have blood tests, like karyotyping, to check for chromosome problems. Karyotyping can count how many chromosomes there are and check to see if any chromosomes have changed. If tissue from the miscarriage is available, your provider can test it for chromosomal conditions.
• Hormone tests. You may have your blood tested to check for problems with hormones. Or you may have a procedure called endometrial biopsy that removes a small piece of the lining of the uterus to check for hormones.
• Blood tests to check your immune system. Your provider may test you for autoimmune disorders like, APS and lupus.
• Looking at the uterus. You may have an ultrasound, a hysteroscopy (when your provider inserts a special scope through the cervix to see your uterus) or a hysterosalpingography (an X-ray of the uterus).

How long does it take to recover from a miscarriage?

It can take a few weeks to a month or more for your body to recover from a miscarriage. Depending on how long you were pregnant, you may have pregnancy hormones in your blood for 1 to 2 months after you miscarry. Most women get their period again 4 to 6 weeks after a miscarriage.

It may take longer to recover emotionally from a miscarriage. You may have strong feelings of grief about the death of your baby. Grief is all the feelings you have when someone close to you dies. Grief can make you feel sad, angry, confused or alone. It’s OK to take time to grieve after a miscarriage. Ask your friends and family for support, and find special ways to remember your baby. For example, if you already have baby things, like clothes and blankets, you may want to keep them in a special place. Or you may have religious or cultural traditions that you’d like to do for your baby. Do what’s right for you.

Certain things, like hearing names you were thinking of for your baby or seeing other babies, can be painful reminders of your loss. You may need help learning how to deal with these situations and the feelings they create. Tell your provider if you need help to deal with your grief. And visit Share Your Story, the March of Dimes online community where you can talk with other parents who have had a miscarriage. We also offer the free booklet From hurt to healing that has information and resources for grieving parents.

If you miscarry, when can you try to get pregnant again?

This is a decision for you to make with your partner and your provider. It’s probably OK to get pregnant again after you’ve had at least one normal period. If you’re having medical tests to try to find out more about why you miscarried, you may need to wait until after you’ve had these tests to try to get pregnant again.

You may not be emotionally ready to try again so soon. Miscarriage can be hard to handle, and you may need time to grieve. It’s OK if you want to wait a while before trying to get pregnant again.

More information

• From hurt to healing (free booklet from the March of Dimes for grieving parents)
• Share Your Story (March of Dimes online community for families to share experiences with prematurity, birth defects or loss)
• Centering Corporation (grief information and resources)
• Compassionate Friends (resources for families after the death of a child)
• Journey Program of Seattle Children’s Hospital (resources for families after the death of a child)
• Lupus Research Alliance: Pregnancy and family planning
• Share Pregnancy & Infant Loss Support  (resources for families with pregnancy or infant loss)

Last reviewed: November, 2017