When you hold onto so many dreams and hopes, only those who have endured the pain of losing them truly understand how devastating it can be. Sometimes, in ways you might never expect during the early weeks of pregnancy, this can happen. Today, we are discussing a topic many find difficult to talk about, yet it is incredibly important: understanding what a miscarriage is.
What exactly is a miscarriage?
Simply put, a miscarriage—often called a ‘spontaneous abortion‘—is the unexpected loss of a pregnancy within the first 20 weeks, or roughly the first 5 months. While it is medically termed a ‘miscarriage,’ it is the first and most important thing for you to understand: this is not your fault. In most cases, these events are beyond your control and occur due to a natural halt in the baby’s development.
What are the different types of miscarriages?
You may be wondering if all miscarriages happen the same way. No, your doctor may classify them in the following ways:
Missed Miscarriage
In this case, you may not even realize that a miscarriage has occurred because you don’t experience the typical symptoms. It is often only during an ultrasound scan that it is confirmed there is no fetal heartbeat. It is truly heartbreaking to receive such news.
Complete Miscarriage
This occurs when the pregnancy tissue is completely passed, and your uterus is empty. You may experience bleeding and the passing of tissue. Your doctor can confirm this via an ultrasound.
Recurrent Miscarriage
This refers to having three consecutive pregnancy losses. It is estimated to affect about 1% of couples. Feeling overwhelmed by this is completely normal.
Threatened Miscarriage
In this scenario, even though your cervix remains closed, you may experience bleeding and lower abdominal pain, similar to menstrual cramps. However, in many cases, the pregnancy continues without complications. Your doctor will simply monitor you more closely throughout the pregnancy. Staying calm and following medical advice is vital here.
Inevitable Miscarriage
Here, you may experience bleeding and abdominal pain, while your cervix begins to open. Sometimes, the ‘amniotic fluid’ surrounding the baby may leak. In these instances, the likelihood of a complete miscarriage is high.
How will I know if I am having a miscarriage? (Symptoms)
Sometimes a miscarriage may happen without you realizing it. However, if symptoms do occur, these are the most common signs:
- Gradually increasing vaginal bleeding. You may sometimes notice greyish tissue or blood clots.
- Lower abdominal pain and cramping. This is generally more intense than typical menstrual cramps.
- Back pain. This can start slowly and intensify or remain at a moderate level for some.
- A decrease in pregnancy symptoms. For example, you may notice a sudden reduction in dizziness or morning sickness.
If you experience any of these symptoms, please contact your healthcare provider immediately.They will guide you on whether to visit the clinic or proceed to the emergency department. While it is hard not to panic, taking swift action is essential.
What causes a miscarriage?
Many wonder, ‘Why did this happen to me?’ or ‘Did I do something wrong?’ In reality, most miscarriages are not caused by anything you did. Let’s look at the primary reasons.
Chromosomal Abnormalities
In the first trimester—up to about 13 weeks of pregnancy—about 50% of miscarriages are caused by chromosomal abnormalities. Chromosomes carry our genes, which determine traits like hair color, eye color, and blood type. When an egg and sperm unite, they combine their genetic material. If there are too many or too few chromosomes, the embryo may not develop properly. These chromosomal issues usually happen by chance, and the exact reason why is often unknown.
Other contributing factors
Beyond chromosomal issues, several other factors can contribute to a miscarriage:
- Infections.
- Exposure to TORCH infections (e.g., Toxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex).
- Hormonal imbalances.
- Improper implantation of the fertilized egg into the uterine wall.
- Advanced maternal age. The risk slightly increases with age.
- Uterine abnormalities (e.g., structural variations, fibroids).
- Incompetent cervix (where the cervix opens too early).
- Lifestyle factors like smoking, alcohol consumption, or illicit drug use.
- Autoimmune disorders such as Lupus.
- Severe kidney disease.
- Congenital heart disease.
- Unmanaged diabetes.
- Thyroid disease.
- Exposure to radiation.
- Certain medications, such as Isotretinoin (Accutane®) used for acne.
- Severe malnutrition.
Most importantly, there is no scientific evidence that stress, exercise, sexual activity, or long-term use of birth control pills causes a miscarriage. No matter your situation, please do not blame yourself. Most miscarriages happen for reasons beyond your control. Understanding this can be a crucial step in your healing process.
How painful is a miscarriage?
This experience is truly unique to every individual. Some may experience intense lower abdominal pain and cramping, while others might feel discomfort similar to typical menstrual cramps. The intensity often depends on the type of miscarriage you are experiencing. For example, if you are having a 'complete miscarriage' at home, you might experience more discomfort than someone undergoing a surgical procedure to remove fetal tissue during a 'missed miscarriage'.
What happens first during a miscarriage, and how long does it take?
It is difficult to predict exactly how a miscarriage starts because symptoms vary. In some cases, there are no outward signs at all, and the miscarriage is only discovered during an ultrasound exam. For many women, however, some level of lower abdominal pain and vaginal bleeding are common initial symptoms. Regardless, the progression is different for everyone.
Similarly, the duration of the process varies significantly. Some women may experience intense pain and heavy bleeding for a longer period than others. Your doctor is the best person to guide you on what to expect and can provide specific advice on managing pain and cramping.
What are the risk factors for a miscarriage?
A risk factor is a characteristic or behavior that increases the likelihood of a specific medical condition. Here are the primary risk factors associated with miscarriage:
- Your Age: Research shows that while the risk of miscarriage for women in their 20s is between 12% and 15%, it increases to about 25% by age 40. Many age-related miscarriages are due to chromosomal abnormalities, where the embryo has an incorrect number of chromosomes.
- Previous Miscarriage: If you have had one prior miscarriage, your risk of another is approximately 25% (this is only slightly higher than for someone who has never had a miscarriage).
- Health Conditions: Unmanaged diabetes, certain infections, or specific structural issues with your uterus or cervix can increase your risk.
Discuss these risk factors with your healthcare provider. They will review your medical history to provide a personalized assessment of your risk.
How common are miscarriages, and how does risk change over time?
It is estimated that 10% to 20% of known pregnancies end in miscarriage. The vast majority (about 80%) occur within the first trimester (the first 13 weeks). Miscarriages after 20 weeks are rare, occurring in less than 5% of cases.
Sometimes, if we count very early losses that occur shortly after implantation, the percentage can be higher. In such instances, because the bleeding often coincides with a regular menstrual cycle, a person might not even realize they were pregnant. This is known as a 'chemical pregnancy'.
The good news is that your risk of miscarriage decreases with each passing week of your pregnancy. While the overall risk is about 15%, the risk during the second trimester (weeks 13 through 19) drops to between 1% and 5%. While your age and overall health play significant roles, if you have no underlying health concerns, the risk of miscarriage continues to decline as your pregnancy progresses.
How is a miscarriage diagnosed?
To confirm a miscarriage, your doctor may perform the following tests:
- Ultrasound Exam: This checks for a fetal heartbeat or the presence of structures like the 'yolk sac', which are typically visible in early pregnancy.
- Blood Tests: These measure levels of human chorionic gonadotropin (hCG), a hormone produced by the placenta. Consistently low or falling hCG levels can confirm a miscarriage.
- Pelvic Exam: This is used to check if your cervix has begun to dilate (open).
How are miscarriages treated?
If you experience a miscarriage, it is crucial to ensure the uterus is completely emptied. If any pregnancy-related tissue remains, you may be at risk for infection, heavy bleeding, or other complications.
If the miscarriage is 'complete'—meaning all fetal tissue has passed naturally—no further treatment is usually required. Your doctor will confirm this with an ultrasound.
However, if the tissue has not passed completely, or if bleeding has not yet started, your doctor may recommend medication or a surgical procedure to clear the tissue.
Nonsurgical Treatment
Your doctor may suggest waiting for your body to pass the tissue naturally, especially in cases of a 'missed miscarriage'. However, this process can take several days. If waiting is not medically safe, or if you prefer to expedite the process, your doctor can prescribe medication to help the uterus empty. These options are typically only available if you are less than 10 weeks pregnant.
Even if a miscarriage isn't confirmed but you show symptoms, your doctor might recommend bed restfor a few days, or an overnight hospital stay for observation. Once bleeding stops, you can generally resume normal activities. If your cervix is found to be opening prematurely, this may be identified as an 'incompetent cervix,' and a surgical procedure known as 'cervical cerclage' may be performed to keep it closed.
Surgical Treatment
If the tissue remains in the uterus or if you are experiencing heavy bleeding, your doctor may perform a D&C (Dilation and Curettage) or a D&E (Dilation and Evacuation). If you are past 10 weeks of pregnancy, surgery is often the preferred option. During these procedures, the cervix is dilated, and the remaining tissue is removed via suction or gentle scraping. These procedures are performed in a hospital setting under anesthesia.
What symptoms follow a miscarriage, and when should you seek help?
After a miscarriage, some spotting and minor discomfort are normal.
However, you must contact your doctor immediately if you experience any of the following, as they may be signs of an infection:
- Heavy bleeding that is increasing or not stopping.
- Fever.
- Chills.
- Severe or worsening pain.
Following a miscarriage, do not insert anything into the vagina for at least two weeks. This includes avoiding the use of tampons, sexual intercourse, or the use of sexual toys. Your doctor will schedule a follow-up appointment to ensure you are healing well and to rule out any complications.
What tests are done for recurrent miscarriages?
If you have experienced three or more consecutive pregnancy losses (a condition known as 'recurrent miscarriage'), your doctor may recommend blood tests or genetic testing. Some of these include:
- Genetic Tests: Both you and your partner can undergo blood tests, such as Karyotyping, to identify any chromosomal abnormalities. If tissue from the pregnancy is available, it can also be tested for these irregularities.
- Blood Tests: Your doctor may order blood tests to check for underlying autoimmune conditions or hormonal imbalances that could potentially lead to pregnancy loss.
Your doctor might also recommend one of the following diagnostic procedures to examine your uterus:
- Hysterosalpingogram: A specialized X-ray procedure that uses contrast dye to visualize your uterus and fallopian tubes.
- Hysteroscopy: A procedure where your doctor uses a thin, telescope-like instrument to look inside your uterus.
- Laparoscopy: A procedure where your doctor uses a lighted instrument to examine your pelvic organs.
Can you get pregnant again after a miscarriage? How soon?
Yes, absolutely. Many women (approximately 87%) go on to have a healthy pregnancy and a baby after a miscarriage. Experiencing a miscarriage does not mean you have a fertility problem. Please remember, most miscarriages occur due to random chromosomal abnormalities—not because of anything you did or did not do.
Deciding when to try for another pregnancy is a choice you should make in consultation with your doctor. Many women are physically able to conceive again after one 'normal' menstrual cycle.
The most important thing is to allow yourself time to heal, both physically and emotionally.Counseling services are available to help you process this loss. Support groups, where you can speak with others who have experienced a similar loss, can be a vital resource for both you and your partner. Ask your healthcare provider about counseling and support group options. Above all, please do not blame yourself. Give yourself the time you need to grieve.
If you have experienced three or more consecutive miscarriages, ask your doctor about further testing to identify any underlying causes. It is advisable to use contraception until the results of these tests are available, at which point your doctor will guide you on when it is appropriate to stop contraception and try to conceive again.
Can another miscarriage be prevented?
In truth, most miscarriages cannot be prevented. If you have had a miscarriage, it is not because of something you did to cause it. The best thing you can do is focus on your well-being. Here are a few ways to care for yourself:
- Attend all your prenatal care appointments faithfully.
- Maintain a healthy weight that is right for you.
- Avoid known risk factors, such as alcohol consumption and smoking.
- Take your recommended prenatal vitamins.
- Engage in regular, moderate exercise and maintain a balanced, healthy diet.
How to cope with the grief of a miscarriage? (Finally, keep these points in mind)
Losing a pregnancy is an emotionally devastating and complex experience that can trigger a range of difficult feelings. The emotional recovery process often takes longer and is more challenging than the physical healing. Give yourself permission to grieve your loss. Share your feelings with your partner, friends, or family. You might also find comfort in an online pregnancy loss support group. Surround yourself with a strong support system, or seek the assistance of a professional counselor to help you navigate this difficult time.
A miscarriage is a deeply sensitive moment for prospective parents, and your grief is completely valid. Please remember, a miscarriage cannot be prevented, and it is not your fault. It does not mean you cannot have children in the future, nor does it mean another miscarriage is inevitable. It is normal to feel sad. Reach out to your loved ones, support groups, or a licensed counselor for support. When you are ready to plan your next pregnancy, schedule an appointment with your doctor to discuss your next steps, timing, and any questions you may have.
Nirogi Lanka | Miscarriage, Pregnancy, Women's Health, Symptoms, Causes, Treatment, Pregnancy Loss
