What Is It?
A miscarriage is the loss of a pregnancy before 20 weeks, the point at which a fetus might be able to survive outside the womb. Miscarriage also is called spontaneous abortion or natural abortion. In a miscarriage, the woman's body expels all or some of the fetus, the placenta and the fluid surrounding the baby.
About 15 percent to 20 percent of known pregnancies end in a miscarriage, and many more occur before a woman recognizes she is pregnant. Most miscarriages occur before 16 weeks, and in many of these cases, the fetus died days or weeks before the symptoms of miscarriage began. In the early weeks, a miscarriage sometimes happens because an embryo did not properly form into a fetus, a situation known as a blighted ovum.
Miscarriage most often happens when the fetus has abnormal chromosomes, the pieces of DNA that contain genes and determine what we are like. These fetal chromosome abnormalities account for approximately 50 percent of all miscarriages. About 95 percent of the time, the parents' chromosomes are normal and the genetic abnormality has developed as a one-time error in the fetus. In such cases, miscarriage is said to be the body's way of ending a pregnancy that is not developing normally.
Miscarriages also can occur if there are problems involving the internal structure of a woman's uterus or the strength of her cervix. A woman's cervix, which should open during labor and delivery to allow the fetus to pass through, is sometimes too weak to keep the fetus safe inside the womb until delivery. When the cervix is too weak and opens early in pregnancy the woman is said to have an incompetent cervix. Problems with the structure of the uterus and incompetent cervix are the most common causes of miscarriage during the first part of the second trimester (12 to 20 weeks).
Other causes of miscarriage include infections and hormonal imbalances. In rare cases, a woman's immune system rejects the fetus. Immune-system disorders are responsible for miscarriages in 5 percent to 10 percent of women who have had three or more miscarriages in a row.
Women with diseases such as poorly controlled diabetes or severe hypothyroidism (underactive thyroid) are at higher risk of miscarriage. Having rubella (German measles) during early pregnancy has been associated with miscarriage. Environmental factors, such as smoking cigarettes and drinking alcoholic beverages during pregnancy, may increase your risk of having a miscarriage. Miscarriage is not caused by regular physical activities, minor accidents, exercise, sexual intercourse, or minor stumbles or falls.
Miscarriages and possible miscarriages are categorized in several ways:
Threatened miscarriage A miscarriage is considered threatened, or possible, when any bleeding from the uterus occurs before 20 weeks, but the cervix is closed and the fetus is alive.
Inevitable abortion or miscarriage A miscarriage is called inevitable, meaning it cannot be stopped, if there is bleeding from the uterus and the cervix is opening prior to 20 weeks, but neither the fetus nor placenta have passed out of the woman's body. The membranes around the fetus may or not have ruptured (broken).
Incomplete abortion or miscarriage A miscarriage is incomplete when only a portion of the fetus or placenta has passed out of the uterus prior to 20 weeks gestation.
Complete miscarriage A miscarriage is complete if the fetus, all the membranes around the fetus and the placenta are expelled completely and the cervix closes prior to 20 weeks.
Missed abortion or miscarriage A missed abortion refers to a miscarriage in which the fetus has died prior to 20 weeks gestation, but neither the fetus nor the placenta has been expelled from the uterus.
Recurrent miscarriage A woman is said to have recurrent miscarriage after three or more miscarriages in a row. Approximately 1 percent of women experience recurrent miscarriages.
Blighted ovum or anembryonic gestation This occurs when a gestational sac forms inside the uterus, but no fetus is present after seven weeks.
Symptoms
Symptoms of miscarriage include:
Vaginal bleeding that may start as a brownish discharge
Cramps in the pelvic area, lower back or abdomen
A decrease in the usual signs of early pregnancy, such as nausea and breast tenderness
Pain in the lower back or abdomen
Tissue or blood clots passing from the vagina
Diagnosis
Your doctor will ask you about your symptoms. If pregnancy tissue has passed out of your vagina, you should try to keep it in a glass jar or plastic container with a tightly sealed lid. Your doctor may want to inspect this tissue.
If miscarriage is suspected or has occurred, your doctor will do a pelvic examination to check the size of your uterus and determine whether your cervix is open or closed. If a miscarriage is in progress then the cervix is usually open and the pregnancy will not survive. If a miscarriage has occurred then the cervix can be either open or closed, depending on whether all the pregnancy tissue has passed out of the womb.
Blood tests usually are obtained to verify your blood type and check the level of human chorionic gonadotropin, or beta-hCG, a hormone released by the placenta into your body when you are pregnant. If the amount of the pregnancy hormone in your system is inappropriately low or repeated tests show the level has decreased over time, a miscarriage may have occurred. An ultrasound may be helpful to identify if a fetus is present, if the fetal heart is beating, or if there is evidence the fetus has died.
If you have saved tissue that has passed out of your vagina, it may be sent to a laboratory to be examined under a microscope. This may help to determine the reason for the miscarriage, or may help to determine whether the miscarriage is complete.
Expected Duration
The amount of discomfort and how much you will have to limit your activity will depend on the length of the pregnancy and how much bleeding and pain you experience with your miscarriage. First-trimester miscarriages may require you to stay home and rest for a few days while you have what seems like a heavy period. The bleeding and crampy pain gradually decrease over one to two weeks.
Prevention
If a miscarriage is about to occur, often you cannot prevent it. However, you may be able to decrease your chances of having another miscarriage by taking good care of yourself, eating a healthy diet, taking folic acid supplements, exercising regularly, and not drinking alcoholic beverages or smoking.
If you have had several miscarriages in a row, your doctor may recommend that you and your partner undergo genetic testing, radiology tests to visualize the form and shape of the uterine cavity and cervix, and possibly a blood test to evaluate your immune system. These tests can help to identify reasons for the recurrent miscarriages.
Treatment
If miscarriage is threatened in the first or early second trimester, your doctor may suggest bed rest, avoiding strenuous exercise and abstaining from sexual intercourse for a period of time. There is little data to support that bed rest and avoiding intercourse prevents miscarriage, but it is common to receive this advice from health care professionals, close friends and family members.
If your pregnancy is in danger because of an incompetent cervix, a suture or stitch (called a cerclage) may be placed around the cervix to tighten it and keep the cervical canal closed. You also may be advised to rest in bed and abstain from sexual intercourse as a precaution. If a cerclage is used, it usually is removed by cutting the stitch after 36 or more weeks of pregnancy. While the cerclage is in place, you will be monitored very closely.
If you have a missed or incomplete miscarriage, your obstetrician/gynecologist may perform a surgery called a dilation and curettage (D & C) to stretch open your cervix gently and remove any remaining fetal tissue from your uterus. If you are in your late second trimester of pregnancy, your doctor most likely will admit you to a hospital and induce labor so that you can deliver the fetus and placenta safely.
If a miscarriage occurs because of an abnormality with the internal structure of your uterus, you may be able to have surgery to correct the problem before getting pregnant again.
When To Call A Professional
Call your obstetrical professional immediately if you have symptoms of a miscarriage, such as vaginal bleeding, severe pain, a foul-smelling vaginal discharge, or if you develop a fever.
Prognosis
Your chances of having another miscarriage depend on the cause of the miscarriage. About 90 percent of women who have had one miscarriage have a healthy pregnancy the next time. However, recurrent miscarriages can increase the risk of future miscarriages. This usually indicates a problem that needs to be addressed, such as an abnormal uterus, a genetic abnormality or a problem with your immune system. The general recommendation for attempting pregnancy after a miscarriage is to wait about two to three months before trying to conceive again.
A miscarriage is the loss of a pregnancy before 20 weeks, the point at which a fetus might be able to survive outside the womb. Miscarriage also is called spontaneous abortion or natural abortion. In a miscarriage, the woman's body expels all or some of the fetus, the placenta and the fluid surrounding the baby.
About 15 percent to 20 percent of known pregnancies end in a miscarriage, and many more occur before a woman recognizes she is pregnant. Most miscarriages occur before 16 weeks, and in many of these cases, the fetus died days or weeks before the symptoms of miscarriage began. In the early weeks, a miscarriage sometimes happens because an embryo did not properly form into a fetus, a situation known as a blighted ovum.
Miscarriage most often happens when the fetus has abnormal chromosomes, the pieces of DNA that contain genes and determine what we are like. These fetal chromosome abnormalities account for approximately 50 percent of all miscarriages. About 95 percent of the time, the parents' chromosomes are normal and the genetic abnormality has developed as a one-time error in the fetus. In such cases, miscarriage is said to be the body's way of ending a pregnancy that is not developing normally.
Miscarriages also can occur if there are problems involving the internal structure of a woman's uterus or the strength of her cervix. A woman's cervix, which should open during labor and delivery to allow the fetus to pass through, is sometimes too weak to keep the fetus safe inside the womb until delivery. When the cervix is too weak and opens early in pregnancy the woman is said to have an incompetent cervix. Problems with the structure of the uterus and incompetent cervix are the most common causes of miscarriage during the first part of the second trimester (12 to 20 weeks).
Other causes of miscarriage include infections and hormonal imbalances. In rare cases, a woman's immune system rejects the fetus. Immune-system disorders are responsible for miscarriages in 5 percent to 10 percent of women who have had three or more miscarriages in a row.
Women with diseases such as poorly controlled diabetes or severe hypothyroidism (underactive thyroid) are at higher risk of miscarriage. Having rubella (German measles) during early pregnancy has been associated with miscarriage. Environmental factors, such as smoking cigarettes and drinking alcoholic beverages during pregnancy, may increase your risk of having a miscarriage. Miscarriage is not caused by regular physical activities, minor accidents, exercise, sexual intercourse, or minor stumbles or falls.
Miscarriages and possible miscarriages are categorized in several ways:
Threatened miscarriage A miscarriage is considered threatened, or possible, when any bleeding from the uterus occurs before 20 weeks, but the cervix is closed and the fetus is alive.
Inevitable abortion or miscarriage A miscarriage is called inevitable, meaning it cannot be stopped, if there is bleeding from the uterus and the cervix is opening prior to 20 weeks, but neither the fetus nor placenta have passed out of the woman's body. The membranes around the fetus may or not have ruptured (broken).
Incomplete abortion or miscarriage A miscarriage is incomplete when only a portion of the fetus or placenta has passed out of the uterus prior to 20 weeks gestation.
Complete miscarriage A miscarriage is complete if the fetus, all the membranes around the fetus and the placenta are expelled completely and the cervix closes prior to 20 weeks.
Missed abortion or miscarriage A missed abortion refers to a miscarriage in which the fetus has died prior to 20 weeks gestation, but neither the fetus nor the placenta has been expelled from the uterus.
Recurrent miscarriage A woman is said to have recurrent miscarriage after three or more miscarriages in a row. Approximately 1 percent of women experience recurrent miscarriages.
Blighted ovum or anembryonic gestation This occurs when a gestational sac forms inside the uterus, but no fetus is present after seven weeks.
Symptoms
Symptoms of miscarriage include:
Vaginal bleeding that may start as a brownish discharge
Cramps in the pelvic area, lower back or abdomen
A decrease in the usual signs of early pregnancy, such as nausea and breast tenderness
Pain in the lower back or abdomen
Tissue or blood clots passing from the vagina
Diagnosis
Your doctor will ask you about your symptoms. If pregnancy tissue has passed out of your vagina, you should try to keep it in a glass jar or plastic container with a tightly sealed lid. Your doctor may want to inspect this tissue.
If miscarriage is suspected or has occurred, your doctor will do a pelvic examination to check the size of your uterus and determine whether your cervix is open or closed. If a miscarriage is in progress then the cervix is usually open and the pregnancy will not survive. If a miscarriage has occurred then the cervix can be either open or closed, depending on whether all the pregnancy tissue has passed out of the womb.
Blood tests usually are obtained to verify your blood type and check the level of human chorionic gonadotropin, or beta-hCG, a hormone released by the placenta into your body when you are pregnant. If the amount of the pregnancy hormone in your system is inappropriately low or repeated tests show the level has decreased over time, a miscarriage may have occurred. An ultrasound may be helpful to identify if a fetus is present, if the fetal heart is beating, or if there is evidence the fetus has died.
If you have saved tissue that has passed out of your vagina, it may be sent to a laboratory to be examined under a microscope. This may help to determine the reason for the miscarriage, or may help to determine whether the miscarriage is complete.
Expected Duration
The amount of discomfort and how much you will have to limit your activity will depend on the length of the pregnancy and how much bleeding and pain you experience with your miscarriage. First-trimester miscarriages may require you to stay home and rest for a few days while you have what seems like a heavy period. The bleeding and crampy pain gradually decrease over one to two weeks.
Prevention
If a miscarriage is about to occur, often you cannot prevent it. However, you may be able to decrease your chances of having another miscarriage by taking good care of yourself, eating a healthy diet, taking folic acid supplements, exercising regularly, and not drinking alcoholic beverages or smoking.
If you have had several miscarriages in a row, your doctor may recommend that you and your partner undergo genetic testing, radiology tests to visualize the form and shape of the uterine cavity and cervix, and possibly a blood test to evaluate your immune system. These tests can help to identify reasons for the recurrent miscarriages.
Treatment
If miscarriage is threatened in the first or early second trimester, your doctor may suggest bed rest, avoiding strenuous exercise and abstaining from sexual intercourse for a period of time. There is little data to support that bed rest and avoiding intercourse prevents miscarriage, but it is common to receive this advice from health care professionals, close friends and family members.
If your pregnancy is in danger because of an incompetent cervix, a suture or stitch (called a cerclage) may be placed around the cervix to tighten it and keep the cervical canal closed. You also may be advised to rest in bed and abstain from sexual intercourse as a precaution. If a cerclage is used, it usually is removed by cutting the stitch after 36 or more weeks of pregnancy. While the cerclage is in place, you will be monitored very closely.
If you have a missed or incomplete miscarriage, your obstetrician/gynecologist may perform a surgery called a dilation and curettage (D & C) to stretch open your cervix gently and remove any remaining fetal tissue from your uterus. If you are in your late second trimester of pregnancy, your doctor most likely will admit you to a hospital and induce labor so that you can deliver the fetus and placenta safely.
If a miscarriage occurs because of an abnormality with the internal structure of your uterus, you may be able to have surgery to correct the problem before getting pregnant again.
When To Call A Professional
Call your obstetrical professional immediately if you have symptoms of a miscarriage, such as vaginal bleeding, severe pain, a foul-smelling vaginal discharge, or if you develop a fever.
Prognosis
Your chances of having another miscarriage depend on the cause of the miscarriage. About 90 percent of women who have had one miscarriage have a healthy pregnancy the next time. However, recurrent miscarriages can increase the risk of future miscarriages. This usually indicates a problem that needs to be addressed, such as an abnormal uterus, a genetic abnormality or a problem with your immune system. The general recommendation for attempting pregnancy after a miscarriage is to wait about two to three months before trying to conceive again.
