Loss of a pregnancy in the first 20 weeks is commonly called a miscarriage. Up to 25% of women will miscarry, most often in the first 13 weeks.
There are different types of miscarriage, including:
- Threatened. Spotting or bleeding in the first trimester may or may not signal a miscarriage.
- Complete. The embryo or fetus, placenta and other tissues are passed with bleeding.
- Incomplete. Only part of the tissues pass. Some stays in the uterus. There may be heavy vaginal bleeding.
- Missed. The embryo or fetus dies, but does not pass out of the uterus. Sometimes dark brown spotting occurs. There is no fetal heartbeat or growth.
- Septic. This is a miscarriage that becomes infected. The mother has a fever and may experience bleeding and discharge with a foul odor. Abdominal pain is common. This is a serious problem and can cause shock and organ failure if not treated.
- Recurrent. Three or more miscarriages.
What are the complications of a miscarriage?
A miscarriage is a significant loss to the woman and her family. It is appropriate and normal to grieve because of the loss.
Pregnancy loss does not usually cause other serious health problems, unless you have an infection or the tissues are not passed. A serious complication with a miscarriage after 20 weeks is severe blood clotting. This is more likely if it took a long time (usually a month or more) to pass the fetus and other tissues.
Women with Rh negative blood may need treatment after a miscarriage to prevent problems with blood incompatibility in a future pregnancy.
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What causes a miscarriage?
About half of early pregnancy losses are from chromosome defects in the embryo or fetus. Other causes may include:
Low hormone levels or a thyroid problem
Scar tissue, fibroids or an abnormally shaped uterus
Incompetent cervix (cannot stay closed)
Injury or trauma
Exposure to toxic substances
Often, the cause of a miscarriage can’t be found.
Who is at risk for miscarriage?
Some things can make miscarriage more likely. They include:
Previous early pregnancy loss
Drinking more caffeine
Low folate level (vitamin B)
Taking NSAIDs around the time of conception
Uterine issues such as fibroids
Celiac disease, high blood pressure, thyroid disease or diabetes
Serious infection or injury
What are the symptoms of a miscarriage?
The most common symptom is vaginal bleeding. It may be painless accompanied by mild to severe back pain or cramping in the abdomen. Some women may pass pregnancy tissue.
How is a miscarriage diagnosed?
Spotting or small amounts of bleeding during the first trimester is common. This may or may not indicate a miscarriage. Your health care provider will likely use an ultrasound to help diagnose miscarriage. Other tests include blood tests for the hormone human chorionic gonadotropin (hCG).
How is a miscarriage treated?
If you have vaginal bleeding, but the lab tests and ultrasound show the pregnancy is OK, your health care provider may tell you to rest for a few days. You will be watched for more bleeding. You may have more hCG blood tests and ultrasound exams to check the growth and heartbeat of the fetus.
If tests show that you have had a miscarriage in the first trimester, you may have several choices. Talk with your health care provider about what is best for you. Treatment choices include:
1. Expectant management. This means waiting to let the miscarriage to happen on its own. You will be checked often during this time.
2. Medical management. This involves medication to help the pregnancy tissues pass.
3. Surgical management. This procedure is called a surgical evacuation of the uterus, or a dilation and curettage (D&C). Anesthesia is used because the procedure can be painful to the mother.
When should I call my doctor?
Tell your health care provider if you have any bleeding during your pregnancy. If you also have other symptoms, such as severe cramping, seek medical attention as soon as possible.
Key points about miscarriage
- Miscarriage is a pregnancy loss in the first 20 weeks.
- Bleeding may or may not be a sign of a miscarriage.
- See your health care provider as soon as possible if you have bleeding and other symptoms such as severe cramping.
- If you have a miscarriage, you may need a procedure to remove the fetus and other tissues, if they have not all been naturally passed.
- If a miscarriage has not occurred, you will probably be told to rest. You and your baby will both be monitored.
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