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Miscarriage

What is a miscarriage?

Miscarriage is the loss of a pregnancy at any time up to the 24th week. A loss after this time is called a stillbirth. 7 or 8 miscarriages out of 10 occur before 13 weeks of pregnancy.

Note: sometimes medical information may refer to a miscarriage as a spontaneous abortion. This may be upsetting as in usual language the word abortion is used to mean a procedure to end a pregnancy.

How common is miscarriage?

About 1 in 7 recognised pregnancies end in miscarriage. Far more pregnancies than this do not make it – as many as half. This is because in many cases a very early pregnancy ends before you miss a period, and before you are aware that you are pregnant.

The vast majority of women who miscarry go on to have a successful pregnancy next time. Recurrent miscarriages (three or more miscarriages in a row), occur in about 1 in 100 women.

What causes miscarriage?

It is thought that most early miscarriages are caused by a one-off chromosomal fault. This is usually an isolated genetic mistake, and rarely occurs again. Such genetic mistakes become more common when the mother is older – that is, over 35 years old. This means women having children when they are over 35 years old are more likely to have a miscarriage.

There are other less common causes of miscarriage. These include: hormonal imbalance, abnormalities of the womb, weakness of the cervix and certain infections like listeria and rubella (German measles). Alcohol abuse, cigarette smoking, illicit drug use and obesity may also increase the risk of miscarriage. If you are overweight, you may be able to reduce your chances of having a miscarriage if you lose weight before you try to get pregnant.

Investigations into the cause of a miscarriage are not usually carried out unless you have three or more miscarriages in a row. This is because most women who miscarry will not miscarry again. Even two miscarriages are more likely to be due to chance than to some underlying cause.

Some myths about the cause of miscarriage

After a miscarriage it is common to feel guilty and to blame the miscarriage on something you have done, or failed to do. This is almost always not the case. In particular, miscarriage is not caused by lifting, straining, working, constipation, straining at the toilet, stress, worry, sex, eating spicy foods, or normal exercise.

There is also no proof that waiting for a certain length of time after a miscarriage improves your chances of having a healthy pregnancy next time.

What is a threatened miscarriage?

It is common to have some light vaginal bleeding sometime in the first 12 weeks of pregnancy. This does not always mean that you are going to miscarry. Often the bleeding settles and the growing baby is healthy. This is called a threatened miscarriage. You do not usually have pain with a threatened miscarriage. If the pregnancy continues, there is no harm done to the baby.

In some cases, a threatened miscarriage progresses to a miscarriage.

What are the symptoms of miscarriage?

The usual symptoms of miscarriage are vaginal bleeding and lower abdominal cramps. You may then pass some tissue from the vagina, which often looks like a blood clot. In many cases, the bleeding then gradually settles. The time it takes for the bleeding to settle varies. It is usually a few days, but can last two weeks or more. For most women, the bleeding is heavy with clots, but not severe – it is more like a heavy period. However, the bleeding can be severe in some cases.

In some cases of miscarriage, there are no symptoms. The fetal heart stops beating, but the fetus remains in the womb. You may have no pain or bleeding. This type of miscarriage may not be found until you have a routine ultrasound scan. This may be referred to by doctors as a missed miscarriage.

The typical pain with a miscarriage is crampy lower abdominal pain. If you have severe, sharp, or one-sided abdominal pain, this may suggest ectopic pregnancy. This is a pregnancy that develops outside the womb. There may be very little blood lost, or the blood may look almost black. A ruptured ectopic pregnancy is a potentially life-threatening situation that needs emergency surgery. You should call an ambulance or go to your nearest Accident and Emergency department if you are worried that you may have an ectopic pregnancy.

Do I need to go to hospital?

You should always report any bleeding in pregnancy to your doctor. It is important to get the correct diagnosis, as miscarriage is not the only cause of vaginal bleeding. If you bleed heavily or have severe abdominal pain when you are pregnant, call an ambulance immediately.

Most women with bleeding in early pregnancy are seen by a doctor who specialises in pregnancy – an obstetrician. This is often in an Early Pregnancy Assessment Unit at your local hospital. It is usual to have an ultrasound scan. This helps to determine whether the bleeding is due to:

  • A threatened miscarriage (a heartbeat will be seen inside the womb).
  • A miscarriage (no heartbeat is seen).
  • Some other cause of bleeding (such as an ectopic pregnancy – no pregnancy inside the womb).

Do I need any treatment?

Once the cause of bleeding is known, your doctor will advise on your treatment options.

For many years it was common to do a small operation to clear the womb following a miscarriage or partial (incomplete) miscarriage. This was often called a D&C.; The logic was that this would make sure all pregnancy tissue was gone and prevent infection or prolonged bleeding. However, recent evidence shows that an operation is not needed in most cases.

Many women now opt to “let nature take its course”. In most cases the pregnancy tissue is passed out naturally and the bleeding will stop within a few days. An operation can still be an option if the bleeding does not stop within a few days, or if bleeding is severe.

In some cases you may be offered what doctors call medical treatment for your miscarriage. That is, you may be offered medication to take either by mouth or to insert into the vagina. The medication helps to clear the womb and can have the same effect as an operation. You do not usually need to be admitted to hospital for this. You may continue to bleed for up to three weeks when medical treatment is used. However, the bleeding should not be too heavy. Many women prefer this treatment because it usually means that they do not need to be admitted to hospital and do not need an operation.

Feelings

Many women and their partners find that miscarriage is distressing. Feelings of shock, grief, depression, guilt, loss and anger are common.

It is best not to bottle up feelings but to discuss them as fully as possible with husbands or partners, friends, with a doctor or midwife, or with someone who can listen and understand. As time goes on, the sense of loss usually becomes less. However, the time this takes varies greatly. Pangs of grief sometimes recur out of the blue. The time when the baby was due to be born may be particularly sad.

Further help

The Miscarriage Association

c/o Clayton Hospital, Northgate, Wakefield, West Yorkshire, WF1 3JS
Tel: (Contact) 01924 200795 Helpline: 01924 200799
Web: www.miscarriageassociation.org.uk
A national charity which supplies support and information on pregnancy loss. It co-ordinates a network of volunteer telephone contacts and support groups.

Scottish Care and Information on Miscarriage (SCIM)

285 High Street, Glasgow, G4 0QS
Tel: 0141 552 5070 Web: www.miscarriagesupport.org.uk
A charity managed by people in Scotland who have themselves had a miscarriage.

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