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Miscarriage

A miscarriage is a pregnancy that ends before 24 weeks, which is before most developing babies are able to survive outside the womb (uterus). 

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.  

Miscarriage is very common, and occurs in about one in five pregnancies. Most happen in the first 12 weeks of pregnancy.

Recurrent miscarriages are when you lose three or more pregnancies in a row. This is uncommon and affects only one in every 100 couples.

If you have a miscarriage, even recurrent miscarriages, it's unlikely that you have an underlying medical problem, and most women go on to have a successful pregnancy in the future. 

There are different types of miscarriage as described below.

  • Threatened miscarriage. This is when you have bleeding early in your pregnancy and your cervix (the opening to your womb) is tightly closed. Your pregnancy is likely to continue if an ultrasound scan shows the heartbeat of your developing baby.
  • Inevitable miscarriage. This is when you have bleeding early in your pregnancy and your cervix is open, which means your pregnancy will be lost.
  • Incomplete miscarriage. This is when a miscarriage has started but there is still some tissue left in your womb. Your cervix is usually open.
  • Complete miscarriage. This means that your pregnancy has been lost. Your womb is empty and your cervix has closed.
  • Delayed or missed miscarriage. This means that although your developing baby has died, you haven’t had any bleeding and didn’t lose any tissue straight away. 

The most common symptom of a miscarriage is bleeding from your vagina. This can vary from light spotting to bleeding that is heavier than your period. You may see blood clots or a brown discharge. You can also have cramps and pain in your abdomen (tummy), pelvis or back.

Some people don’t have any symptoms and their miscarriage may only be discovered in a routine scan.

If you have bleeding from your vagina at any time during pregnancy, you should contact your GP or midwife immediately for advice. 

About half of all early miscarriages happen because of a problem in the way your genetic material (chromosomes) combined when your egg and your partner's sperm joined during fertilisation. You may never find out why this has happened, but it's more likely to be due to chance than to any underlying problem with either you or your partner.

Other factors that can make a miscarriage more likely include:

  • problems with your immune system
  • having an infection, such as listeria or malaria
  • your age – half of all pregnancies in women over the age of 42 end in miscarriage
  • a physical problem with your reproductive system
  • health problems, such as poorly controlled diabetes, a kidney disease or polycystic ovarian syndrome
  • drinking alcohol while you're pregnant
  • smoking while you’re pregnant

There isn't any evidence to show that stress is a risk factor for miscarriage, but it's a good idea to take time during the day to relax.

Moderate exercise or having sex while you're pregnant doesn't increase your risk of miscarriage.

Often you won't know what has caused your miscarriage. If you have already started to miscarry there is nothing that can be done to prevent it.

Your doctor will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP may refer you to a gynaecologist (a doctor who specialises in women's reproductive health), or to an early pregnancy assessment unit at a hospital to have further tests, including those listed below.

  • An ultrasound scan uses sound waves to produce an image of the inside of your womb.
  • Blood and urine tests can measure hormones associated with pregnancy called beta-human chorionic gonadotrophin and progesterone.
  • An examination of your pelvis to check the source of any bleeding. 
If you have recurrent miscarriages, your GP may refer you and your partner to a gynaecologist to have some tests to rule out a specific cause. Possible causes include a hormonal disturbance, inherited problems, abnormalities of your womb, or a condition where your body's own defence mechanism attacks itself, leading to blood clots forming in the placenta. 

If your miscarriage is complete, you won't usually need any further treatment. For an incomplete or missed miscarriage, or when you have a lot of bleeding, you may need treatment with medicines or surgery to remove the remaining fetal tissue. However, some women may prefer to let nature take its course (this is called expectant management).

Your chances of having a healthy pregnancy in the future are just as good whichever method you choose. 

Expectant management

This allows the pregnancy to leave your body naturally. It can take some time before any bleeding starts and it’s normal for this to continue for up to three weeks, along with tummy cramps. You may need to take medicines or have surgery if this method isn’t successful.

Medicines

Medicines will open your cervix and allow fetal tissue to pass out. You may be advised to swallow tablets or a pessary can be inserted directly into your vagina. The effects of the tablets usually begin within a few hours. You will experience symptoms similar to a heavy period, such as cramps and vaginal bleeding. The bleeding can continue for several weeks, although it won’t be heavy for very long.

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

You may need to have surgery if medicines are unsuccessful.

Surgery

Whether or not you need surgery to remove any tissue will depend on the stage of your pregnancy, the amount of bleeding you're having, and your own preferences.

Surgery for miscarriage is a short procedure to empty your womb. It's known as an evacuation of retained products of conception (ERPC). Your surgeon will pass a soft plastic tube through your cervix into your womb and the remaining tissue will be removed by suction.

The operation is usually done as a day case under general anaesthesia. This means you will be asleep during the operation. Alternatively, you may be given the option of local anaesthesia. This blocks pain from the area and you will stay awake during the operation.

ERPC is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications. These include:

  • excessive bleeding
  • a perforation or small hole made in your womb during the procedure (which may require surgery to repair it)

Ask your surgeon to explain these risks to you.

Late miscarriages

If you have a miscarriage between 14 and 24 weeks, you will probably have to go through labour and delivery. The miscarriage may be spontaneous, or labour may need to be induced. You will have some bleeding and possibly period-like pain in the days after the delivery and for several weeks. Your breasts may produce milk.

It may be possible to have a post-mortem on your baby, which may provide information about what caused the miscarriage and possibly help your doctor to care for you if you have a future pregnancy. 

Every pregnancy is at risk of miscarriage; however, if you drink alcohol or smoke, your risk of having one is higher (see Causes of miscarriage).You can help to reduce your risk of pregnancy problems by eating a balanced diet, losing any excess weight and by not drinking too much or smoking. 

The physical effects of a miscarriage tend to clear up quickly. Your next period is likely to follow between four and eight weeks later but it may take several cycles to re-establish a regular pattern.

You may feel physically ready to return to normal activities (such as exercising and going back to work) around a week after an operation, or a few days after treatment with medicines or expectant management. However, the emotional impact of having a miscarriage can be much greater than the physical effects.

A miscarriage can cause a range of feelings. Everyone reacts differently and there is no right or wrong way to feel. It can be equally difficult for your partner and it’s important to get the support you both need. You could consider contacting support groups where you can talk with people who may have similar experiences to you.

You may decide to begin trying for another baby right away or you may think this is too soon and you need longer to recover emotionally. There is no right or wrong thing to do, you need to do what you feel is best for you and your partner. You may be advised by your doctor to wait until you have had at least one period before trying again, although it's safe to have sex when the bleeding and any other symptoms have completely settled and you both feel ready. 

Is there anything I can do to reduce my risk of having a miscarriage?

Answer

Although you cannot prevent a miscarriage, there are a number of things you can do to reduce your risk of having one.

Explanation

Drinking alcohol while you're pregnant has been shown to increase your risk of having a miscarriage. If you choose to drink alcohol during pregnancy, drink no more than one to two units once or twice a week. One unit equals half a pint of ordinary strength lager or beer, or one shot (25ml) of spirits. A small glass (125ml) of wine is equal to one and a half units.

Although there is no absolutely safe level of alcohol consumption during pregnancy, there is no evidence to suggest that this low level of alcohol causes any harm to your unborn baby. You shouldn't get drunk or binge drink while you're pregnant, as this can be harmful to your baby.

Listeriosis is an illness with mild, flu-like symptoms which can be caused by listeria bacteria in certain foods. Listeriosis can cause a miscarriage. To reduce your risk of a listeria infection, don’t eat or drink:

  • milk which isn't pasteurised or UHT
  • ripened soft cheese such as camembert, brie and blue-veined cheese
  • pâté (any type, including vegetable pâté)
  • undercooked ready-made meals

It's safe for you to eat hard cheeses (such as Cheddar), cottage cheese and processed cheese.

If you’re pregnant and get malaria, this can increase your risk of a miscarriage. It’s best not to visit any countries where there is a risk of malaria while you're pregnant. If you have to travel to a country where malaria is present, speak to your GP for advice before you travel.

Smoking can also increase your risk of a miscarriage. If you smoke, then you should stop before you try for another pregnancy.

When can I try for another baby after a miscarriage?

Answer

You will probably be fertile in the first month after a miscarriage. However, the best time to try again for another baby is when you and your partner feel physically and emotionally ready.

Explanation

Most miscarriages occur as a one-off event and there is a good chance you will have a successful pregnancy in the future. If your miscarriage has finished, then you won't need any further medical treatment. If your miscarriage is incomplete and there is still some fetal tissue in your womb (uterus), you will need treatment before trying for another baby. Your doctor will advise you to wait until your symptoms have completely gone and you have stopped bleeding before you have sex.

You will probably have a period within four to eight weeks after your miscarriage but it may take several cycles to re-establish a regular pattern. As ovulation occurs before your period, you will be fertile during this time. If you don't want to become pregnant, use contraception.

Losing a pregnancy is a deeply personal experience that affects everyone differently. It can affect you, your partner and other members of your family. The best time to try again for another baby is when you and your partner feel physically and emotionally ready. If you have any concerns about trying for another baby, it may help to talk to your GP or a counsellor.

Can having a stitch in my cervix reduce my risk of having a miscarriage?

Answer

If you're at high risk of having a late miscarriage. And tests have found that you have a weakness in your cervix (opening of your womb) which allows it to dilate too soon, your doctor may suggest that you have a stitch inserted in your cervix (a cervical stitch or cerclage). This will keep it closed during your pregnancy and reduce your risk of a miscarriage.

Explanation

The cervix normally stays tightly closed during pregnancy. Occasionally it starts to open early, leading to a miscarriage. If you have a miscarriage in the second or third trimester of pregnancy, this may indicate that you have a weakness in your cervix which allows it to dilate (open) too soon. Your gynaecologist (a doctor who specialises in women's reproductive health) may suggest that you have a stitch inserted in your cervix (a cervical stitch or cerclage). This will give it more support and will help to keep your cervix closed during your pregnancy and reduce your risk of a miscarriage.

The operation is usually performed after 12 weeks of pregnancy and removed after 37 weeks. A cervical stitch can also be used before you get pregnant or in an emergency situation if you appear to be at risk of having a miscarriage.

The operation is often carried out through the vagina, but it may also be carried out through the abdomen (tummy) as either open surgery or keyhole surgery. A cervical stitch can carry some risks such as bleeding, infection and miscarriage. Your gynaecologist will explain these to you.

You will need to give birth by caesarean section if you have the cervical stitch.

Evidence to support this technique is limited and research suggests that it shouldn't be used if you're only at a low or medium risk of having a miscarriage. Seek routine antenatal care early in your pregnancy if you have a history of second- or third-trimester miscarriage.

Seek medical help immediately if you have painful or regular womb contractions or vaginal bleeding during the second and third trimester of pregnancy.

Did my miscarriage happen because of something I did?

Answer

That's very unlikely. Miscarriages are very common and the things that most often cause miscarriages can't be prevented.

Explanation

It's very unlikely that your miscarriage happened because of something you did. Miscarriages are very common. The main cause of miscarriage is a problem with the way your genetic material (chromosomes) combined when the sperm fertilised the egg. This is often due to chance so there is nothing you can do to prevent it. Also, once a miscarriage starts, there isn't anything you can do to stop it.

Some of the things that haven't been shown to increase your risk of miscarriage include:

  • being under stress
  • doing moderate exercise during pregnancy
  • having sex during pregnancy

So having a stressful day, going to the gym or having sex won't have caused your miscarriage.

You may find it helpful to talk about your miscarriage with your doctor or other people who have had a similar experience.

What's a missed miscarriage? Is it a 'real' miscarriage?

Answer

Yes. A missed miscarriage is where the developing baby dies but the fetal tissue stays in the womb. Sometimes there aren't any symptoms, and you may not realise you have had a missed miscarriage until you have a routine scan.

Explanation

A missed miscarriage is where the tissue isn't expelled from the womb.

Women who have a missed miscarriage sometimes continue to have pregnancy symptoms, such as feeling tired, because pregnancy hormones are still being produced by the placenta. Many women who have a missed miscarriage only find out during a routine scan.

Some women do have symptoms, and these can include:

  • decreasing pregnancy symptoms, such as tiredness and feeling sick
  • discharge from the vagina that starts off brown in colour and then becomes bright red

If you have a missed miscarriage, it's important that the fetal tissue is removed from your womb to prevent you getting an infection.

Your doctor may recommend medicines or surgery to remove the tissue. Or, you can wait for your womb to expel the fetal tissue, this is called expectant management.

With expectant management, it can take some time for the bleeding to start (due to the tissue being expelled) and it's normal for the bleeding to carry on for about three weeks. The bleeding may be heavier than your period and you may also get a cramping pain. Seek urgent medical attention if:

  • you're concerned about the pain or the amount of bleeding
  • you start having vaginal discharge with an unpleasant smell
  • you start feeling faint
  • you get flu-like symptoms, such as a high temperature
  • you have pain in your shoulders

Further Information

Sources

  • Neilson JP, Gyte G, Hickey M, et al. Medical treatments for incomplete miscarriage (less than 24 weeks). Cochrane Database of Systematic Reviews 2010, issue 1. doi: 10.1002/14651858.CD007223.pub2
  • Devaseelan P, Fogarty PP, Regan L. Human chorionic gonadotrophin for threatened miscarriage. Cochrane Database of Systematic Reviews 2010, issue 5. doi: 10.1002/14651858.CD007422.pub2
  • Miscarriage. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 31 August 2010
  • Couples with recurrent miscarriage: what the RCOG guideline means for you. Royal College of
  • Obstetricians and Gynaecologists. www.rcog.org.uk, published August 2004
  • Listeria factsheet. Health Protection Agency (HPA). www.hpa.org.uk, published April 2009
  • Antenatal care: routine care for the healthy pregnant woman. National Institute for Health and Clinical Excellence (NICE), March 2008. www.nice.org.uk
  • Early miscarriage: information for you. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published January 2008
  • Early pregnancy loss. eMedicine. www.emedicine.medscape.com, accessed 31 August 2010
  • Leaflets. The Miscarriage Association. www.miscarriageassociation.org.uk, accessed February 2010
  • Joint Formulary Committee. British National Formulary. 60th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2010
  • Laparoscopic cerclage for prevention of recurrent pregnancy loss due to cervical incompetence. National Institute for Health and Clinical Excellence (NICE), 2007 Interventional procedure guidance 228. www.nice.org.uk
  • Drakeley AJ, Roberts D, Alfirevic Z. Cervical stitch (cerclage) for preventing pregnancy loss in women (review). Cochrane Database of Systematic Reviews 2003, issue 1. doi: 10.1002/14651858.CD003253 

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