Miscarriage

A miscarriage is the sudden loss of a pregnancy within the first 20 weeks of gestation. Up to 1 in 5 women who know they are pregnant will miscarry.

Most miscarriages that occur in the first 12 weeks of pregnancy are caused by genetic problems. Most early miscarriages can't be prevented or stopped.

Later miscarriages may be due to problems with a woman's reproductive system, such as the cervix, uterus, placenta, or because of other complications of pregnancy. Infection and blood-clotting problems can also cause miscarriage.

Symptoms of miscarriage

The most common signs of miscarriage are:

• vaginal spotting or bleeding
• cramping in the lower abdomen or back
• passing tissue, blood clots, or fluid

Bleeding may also be a sign that the embryo has implanted outside the uterus, often in one of the fallopian tubes. If you experience any bleeding during pregnancy, call your doctor or midwife as soon as you can.

Some embryos stop developing with no symptoms of a miscarriage. This is called a missed miscarriage. It is often discovered during a routine prenatal checkup.

Diagnosing miscarriage

A variety of tests can determine if a miscarriage has occurred.

• A blood test for human chorionic gonadotropin, a hormone that usually rises during pregnancy, can detect a miscarriage or ectopic pregnancy. Worrisome signs are a slowly rising level of the hormone or a decrease in the level.
• An ultrasound can show that an embryo is underdeveloped for its age or has no heartbeat. An ultrasound can also show if an embryo is growing outside the uterus, usually in a fallopian tube.
• Tests on tissue that have been passed through the vagina can look for chromosome problems.

Recovering from miscarriage

Physical recovery from an early miscarriage is usually straightforward. If you have a missed or incomplete miscarriage early in pregnancy, there are three main options:

• You may decide to watch carefully for problems but let the miscarriage resolve on its own.
• If bleeding is heavy, pain is severe, or you are uncomfortable waiting, talk with your doctor or midwife about having a dilation and curettage to remove any remaining fetal tissue from your uterus.
• Medication can help speed the passage of tissue.

Your clinician may follow you with blood tests to be sure no tissue from the pregnancy remains in your body.

Miscarriage can be emotionally devastating. People who haven't experienced it may not know what to say or do to help. It can take time to work through your grief. If you're struggling, talk with your clinician. She or he may be able to suggest sources of support beyond your family and friends.

Many women who have had a miscarriage want to know when they can try to become pregnant again. Some experts recommend waiting for three menstrual cycles, but there is no research to support this recommendation. It is usually safe to try to conceive after one normal period. It can be helpful to talk with your doctor or midwife about planning your next pregnancy — especially if you have had more than one miscarriage.