Miscarriage: Signs, causes, and treatment

 

What is a miscarriage?

A miscarriage is an event that results in the loss of a fetus during early pregnancy. It’s also called a spontaneous abortion. It typically happens during the first trimester, or first three months, of the pregnancy. According to the American Pregnancy Association (APA), 10 to 25 percent of all clinically recognized pregnancies end in miscarriage.


The cause of a miscarriage varies from person to person. Often the cause is unknown. Miscarriages that occur after three months, or between 14 to 26 weeks, are usually due to an underlying health condition in the mother.

Signs and symptoms of a miscarriage

The symptoms of a miscarriage vary, depending on your stage of pregnancy. In some cases, it happens so quickly that you may not even know you’re pregnant before you miscarry.
Here are some of the symptoms of a miscarriage:

• mild to severe back pain
• heavy spotting
• vaginal bleeding
• expulsion of tissue with clots from your vagina
• severe abdominal pain
• cramps

Call your doctor right away if you experience any of these symptoms during your pregnancy. It’s also possible to have these symptoms without experiencing a miscarriage. But your doctor will want to conduct tests to make sure that everything is fine.

Types of miscarriage

There are many different types of miscarriage. Depending on the cause of your miscarriage and stage of your pregnancy, your doctor will classify your condition as a:

• blighted ovum, where a fertilized egg implants into your uterine wall, but fetal development never begins
• complete miscarriage, where the products of conception are expelled from your body
• incomplete miscarriage, where the membranes are ruptured, and your cervix is dilated or thinned
• missed miscarriage, where the embryo dies without your knowledge, and you don’t deliver it
• recurrent miscarriage, where you’ve had three or more consecutive first-trimester miscarriages
• ectopic miscarriage, where an egg implants somewhere other than your uterus, usually in your fallopian tubes
• threatened miscarriage, where bleeding and cramps point to a possible upcoming miscarriage.

Causes of miscarriage

During pregnancy, your body supplies hormones and nutrients to your developing fetus. This helps your fetus develop normally during your pregnancy. Most first trimester miscarriages happen because the fetus doesn’t develop normally. There are different factors that can cause this.

Genetic or chromosome issues

About 50 percent of miscarriages are due to chromosome issues. Errors occur randomly when the cells of the embryo divide, or are due to a damaged egg or sperm cell. Problems with the placenta can also lead to a miscarriage.


Examples of these chromosome abnormalities include:

• intrauterine fetal demise: The embryo forms but stops developing before you see or feel symptoms of pregnancy loss.
• blighted ovum: No embryo forms at all.
• molar pregnancy: Molar pregnancies are rare. There is usually an abnormal placenta growth, but since both sets of chromosomes come from the father, no fetal development occurs.
• partial molar pregnancy: This happens when the mother’s chromosomes remains, but the father has also provided two sets of chromosomes. This causes placenta abnormalities and an abnormal fetus.

External health conditions

External health conditions, lifestyle habits, and underlying conditions may also interfere with the fetus’ development, especially in the second trimester. Exercise and sexual intercourse do not cause miscarriages. Working won’t affect the fetus either unless you’re exposed to harmful chemicals or radiation.


Conditions that can interfere with a fetus’ development include:

• poor diet, or malnutrition
• drug and alcohol use
• advanced maternal age
• untreated thyroid disease
• uncontrolled diabetes
• infections
• trauma
• obesity
• problems with the cervix
• abnormally shaped womb
• severe high blood pressure
• food poisoning
• certain medications. 

Always check with your doctor before taking any medications to be sure a drug is safe to use during pregnancy.

Risk factors

Most miscarriages are due to natural and unpreventable causes. However, certain risk factors can increase your chances of having a miscarriage. These include:

• body trauma
• radiation exposure
• drug use
• alcohol abuse
• excessive caffeine consumption
• smoking
• previous miscarriage
• being underweight or overweight
• chronic, uncontrolled conditions, like diabetes

Being at an older age can also affect your risk for miscarriages.

Age	Risk of having a miscarriage
under 30 years of age	1 in 10
35 to 39 years of age	2 in 10
over 45 years of age	more than half.

Having one miscarriage doesn’t increase your risk for having other miscarriages. Only one in 100 women experience three or more miscarriages in a row. Over 60 percent of these women also go on to carry a baby to full-term.

Preventing miscarriages

Not all miscarriages can be prevented, but having a miscarriage doesn’t mean you won’t conceive again in the future. According to the Mayo Clinic, only a small number of women have two or more miscarriages. Most women who miscarry have healthy pregnancies later.


Some recommendations for a healthy pregnancy include:

• Avoid alcohol, drugs, and smoking while pregnant.
• Engage in light regular exercise to improve fetal health.
• Maintain a healthy weight before and during pregnancy.
• Avoid infections. Wash your hands thoroughly and stay away from people who are already sick.
• Limit the amount of caffeine to no more than 200 milligrams per day.
• Take prenatal vitamins to help ensure that you and your developing fetus get enough nutrients.
• Eat a healthy, well-balanced diet with lots of fruits and vegetables.

Recovering from a miscarriage

Your body’s recovery will depend on how far along your pregnancy was before the miscarriage. After a miscarriage, you might experience the following symptoms:

• vaginal bleeding like a menstrual period or spotting
• lower abdominal pain or cramps
• discomfort or engorgement in the breast.

While pregnancy hormones might last in the blood for a couple months after a miscarriage, you should start having normal periods again in three to six weeks. You can resume your normal activities as soon as you feel ready to do so. Listen to your body. It’s important that you give yourself time to heal physically and emotionally.

Miscarriage support

It’s normal to experience a range of emotions after a miscarriage. You may also experience the following symptoms:

• trouble sleeping
• loss of appetite
• restlessness
• low energy
• frequent crying

These symptoms may become serious and get worse without treatment.


You may also want to consider the following:

• Reach out for help if you are overwhelmed. Your family and friends may not understand how you’re feeling, so let them know how they can help. Even helping with housework, cooking, or child care may be helpful.
• Read literature about miscarriage and bereavement.
• Store away any baby memorabilia, maternity clothing, and baby items until you are ready to see them again may help with your recovery.

Take your time to grieve for your loss, but also remember that support is all around you. You can also seek counseling from a therapist. Grief counselors can help you cope with feelings of depression, loss, or guilt. Online support forums and chat rooms can be helpful for women who want to talk about their miscarriage with others who have been through the same situation.

Getting pregnant again

You may want to ask your doctor to help you develop a conception plan before you try to get pregnant again. Being as healthy as possible can help you prepare for a pregnancy and lower your risk of another miscarriage.


Your doctor will likely recommend tests to detect any problems that may have caused your previous miscarriage. These may include:

• blood tests to detect hormone imbalances
• chromosome tests, using blood or tissue samples
• pelvic and uterine exams
• ultrasounds

Your doctor may recommend that you wait several months before getting pregnant again. Depending on your health, your doctor may also require periodic testing throughout your pregnancy.


Remember that most miscarriages are out of your control. Healing doesn’t mean you have to forget about what happened. A symbolic gesture may also help with the experience. Some women plant a tree, or wear a special piece of jewelry.