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Miscarriage

Published by Bupa's health information team, May 2009.

This factsheet is for women who have had a miscarriage, or who would like information about it.

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

• About miscarriage
• Symptoms of miscarriage
• Causes of miscarriage
• Diagnosis of miscarriage
• Treatment of miscarriage
• Recurrent miscarriage
• Prevention of miscarriage
• After a miscarriage
• Questions and answers
• Related topics
• Further information
• Sources

About miscarriage

Miscarriage is very common, and occurs in three out of every 10 pregnancies. Most miscarriages happen in the first 12 weeks of pregnancy. Having a miscarriage doesn't mean that you won't be able to get pregnant again, and most women go on to have a successful pregnancy in the future.

Symptoms of miscarriage

The most common symptom of miscarriage is vaginal bleeding. This can vary from light spotting to bleeding that is heavier than your period. You may also see blood clots, a brown discharge, or other tissue that isn't clearly identifiable.

You can often get cramping and pain in your pelvis or back. You may find that the usual symptoms of pregnancy, such as breast tenderness, feeling sick and having to pass urine more frequently than usual, stop unexpectedly.

Sometimes there are no symptoms and your miscarriage may only be discovered in a routine scan.

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

Causes of miscarriage

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 has 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.

Imbalances in pregnancy hormones, problems with your immune system, and some infections such as listeriosis (Listeria infection) and malaria are also thought to make miscarriages more likely.

Miscarriages become more common as you get older, because egg quality decreases with age. If you drink alcohol while you're pregnant, your risk of having a miscarriage is higher. It's also higher with multiple pregnancies, such as twins. Smoking may increase the risk of miscarriage, so you should stop smoking during pregnancy.

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

Doing moderate exercise or having sex whilst you're pregnant doesn't increase your risk of miscarriage.

You're slightly less likely to have a miscarriage if you previously took the contraceptive pill.

Often you won't know what has caused your miscarriage. If you have already started to miscarry there is very little that can be done to prevent it.

Diagnosis of miscarriage

Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history, and may give you an internal examination.

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 (uterus). If you're in the early stages of pregnancy (less than six to seven weeks), it's sometimes not possible to tell if your pregnancy is progressing in an unusual way that might indicate a miscarriage. If this is the case, you may need to have another scan in seven to 10 days time.
• Blood tests can be used to find out if you have a rhesus-negative blood group. If you're rhesus negative, you will be offered an injection to prevent a condition called rhesus disease in subsequent pregnancies.
• You may be asked to take a pregnancy test if your pregnancy was not confirmed. This may be repeated 48 hours later to check your hormone levels.

Your GP or gynaecologist may use one of the following terms to describe your type of miscarriage.

• A threatened miscarriage describes bleeding in early pregnancy where your cervix (the opening to your womb) is tightly closed. Your pregnancy should continue if your ultrasound scan shows the heartbeat of your developing baby.
• An inevitable miscarriage describes bleeding in early pregnancy where your cervix is open, which means your pregnancy will be lost.
• An incomplete miscarriage describes a miscarriage that has definitely started, but there is still some pregnancy tissue left in your womb. Your cervix is usually found to be open.
• A complete miscarriage means that your pregnancy has been lost. Your womb is now empty and your cervix has closed.
• A delayed or missed miscarriage means that although the baby stopped growing and died, you didn't lose any pregnancy tissue straight away. This type of miscarriage usually causes a small amount of dark-brown blood loss. You may get sudden end-of-pregnancy symptoms or you may have no symptoms at all.

Treatment of miscarriage

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 pregnancy tissue, although some women may prefer to let nature takes its course (this is called expectant management).

Expectant management is linked with an increased risk of bleeding, whereas surgical treatment carries a slightly increased risk of infection.

Medicines

Doctors may prescribe mifepristone (Mifegyne) alone or in combination with either misoprostol (Cytotec) or gemeprost. These soften the cervix and make the womb contract so that the remainder of the pregnancy tissue is expelled.

You may get an infection which can make any bleeding last longer and can sometimes cause an unpleasant smelling discharge from your vagina. If this happens, your doctor may prescribe a course of antibiotics such as metronidazole (Zidoval) to clear up any infection.

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

Surgery

Your surgeon will advise you on whether surgery to remove any remaining pregnancy tissue is the best option for you. This may depend on the stage of your pregnancy, the amount of bleeding you're having, and your own preference.

Surgery for miscarriage is a short procedure to empty your womb. It's known as an evacuation of retained products of conception (ERPC or ERPOC).

The operation is usually done as a day case under general anaesthesia. This means you will be asleep during the procedure.

During the procedure, your surgeon will pass a soft plastic tube through your cervix into your womb. The pregnancy material is removed by suction.

Recurrent miscarriage

Some women have more than one miscarriage. Even if you have had two miscarriages, it's unlikely that you have an underlying medical problem, and most women go on to have a successful pregnancy in the future.

After three consecutive miscarriages your GP may refer you to a gynaecologist to have some tests to rule out a specific cause. Possible causes include a hormonal disturbance, genetic problems, abnormalities of your womb, or a condition where your body's own defence mechanism attacks itself, leading to blood clots in the placenta.

Prevention of miscarriage

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.

After a miscarriage

The physical effects of a miscarriage tend to clear up quickly. Any bleeding usually settles down within seven to 10 days. It's best not to use tampons at this stage, so that you reduce the chance of infection. Your next period is likely to follow between four and six weeks later.

The emotional impact of miscarriage can be greater than the physical effects. Miscarriage can cause a range of feelings. Everyone reacts differently and there is no right or wrong way to feel.

Some couples decide that they want to begin trying for another baby right away, while others feel that this is too soon and need longer to recover emotionally. There is no right or wrong thing to do, and you need to do what you feel is best for you. You will usually be advised to wait until you have had at least one period before trying again, although it's safe to have sex when the bleeding has settled and you both feel ready.

Related topics

• Common pregnancy symptoms
• General anaesthesia
• Tests in pregnancy
• Ultrasound in pregnancy
• What to expect during pregnancy

Further information

• Miscarriage Association
  01924 200799
  www.miscarriageassociation.org.uk

Sources

• Shaw RW, Souter PW, Stanton SL. Gynaecology. 2nd ed. Edinburgh: Churchill Livingstone, 1997:303-309
• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007:600-601; 736-737; 766-767
• Phillips A, Rakusen J. The new our bodies, ourselves - infertility and pregnancy loss. 3rd ed. London: Penguin, 1996:437
• Chen BA, Creinin MD. Contemporary management of early pregnancy failure. Clin Obstet Gynecol 2007; 50:67-88. www.clinicalobgyn.com
• Antenatal care - routine care for the healthy pregnant woman. National Institute for Health and Clinical Excellence (NICE), 2008, Clinical Guideline 62. www.nice.org.uk
• Alcohol consumption and the outcomes of pregnancy. Royal College of Obstetricians and Gynaecologists. 2006. RCOG Statement No. 5. www.rcog.org.uk
• Early miscarriage: information for you. Royal College of Obstetricians and Gynaecologists. 2008. www.rcog.org.uk
• Ford JH, MacCormac L. Pregnancy and lifestyle study: the long-term use of the contraceptive pill and the risk of age-related miscarriage. Hum Reprod 1995; 10:1397-1402. http://humrep.oxfordjournals.org
• Arulkumaran A, Symonds IM, Fowlie A. Oxford Handbook of Obstetrics & Gynaecology. Oxford: Oxford University Press, 2004:66-68
• Joint Formulary Committee, British National Formulary. 54th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2007:48; 413-415; 417; 420-422
• The management of early pregnancy loss. Royal College of Obstetricians and Gynaecologists. 2006. Green-top Guideline No. 25. www.rcog.org.uk
• Nanda K, Peloggia A, Grimes D, et al. Expectant care versus surgical treatment for miscarriage. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No: CD003518.pub2. www.cochrane.org
• Personal communication, Dr Robin Crawford, Consultant Gynaecological Oncologist, Spire Cambridge Lea Hospital, Cambridge, 29 August 2008
• Personal communication, Ms Ruth Bender Atik, National Director, Miscarriage Association, 10 September 2008

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.

Publication date: May 2009