Miscarriage: Causes, Signs and Care

A miscarriage is the unexpected loss of a pregnancy before the 20th week. Most happen very early, often before a woman knows she is pregnant, and a miscarriage can happen in any pregnancy.

Why it happens

Most miscarriages occur because the fetus does not develop properly, often because of a genetic problem such as an extra or missing chromosome. In many cases no cause is ever found.

Some factors may raise the chance of a miscarriage:

• problems with the uterus or cervix;
• chronic diseases, including polycystic ovary syndrome, and long-term conditions such as uncontrolled diabetes;
• genetic problems with the fetus;
• being pregnant after age 35;
• smoking, drug use or alcohol use; and
• severe malnutrition.

Signs to watch for

Signs differ from person to person and with how far along the pregnancy is. They can include:

• vaginal spotting or bleeding, with or without pain;
• dark-colored vaginal discharge;
• a gush of fluid or tissue from the vagina; and
• cramping or pain in the belly or lower back.

Some women have spotting in early pregnancy and do not miscarry, but any bleeding is a reason to contact a provider right away. More generally, it can be hard to know what is normal in pregnancy: anything that seems unusual or worrying is worth raising.

Diagnosis

To check whether a miscarriage has happened, a provider may do a pelvic exam to check the cervix, blood tests to confirm the pregnancy and gauge things such as blood loss, and an ultrasound to check the fetus.

Treatment

What care is needed often depends on when in the pregnancy the miscarriage happens:

• Early in pregnancy, there may be no need for treatment at all.
• At 12 weeks or later, a shot may be needed to prevent problems with the Rh factor in future pregnancies.
• If tissue remains in the uterus and there are no signs of infection, a provider may suggest waiting for it to pass naturally.
• If the tissue needs to be removed, that can be done with medicines or with a procedure: dilatation and curettage (D&C) or vacuum aspiration.

Afterward

Losing a pregnancy can be hard whenever it happens, and counseling may help with grief. Anyone who later decides to try again should talk with a provider about the risks. Many women who have had a miscarriage go on to have healthy pregnancies.

Miscarriage can happen to anyone and often cannot be prevented. The advice is to take good care of yourself and start prenatal care visits early in pregnancy.

Sources

• MedlinePlus, U.S. National Library of Medicine, "Miscarriage" (summary from the National Institute of Child Health and Human Development): https://medlineplus.gov/miscarriage.html