Overview
A miscarriage is the loss of a pregnancy in the early months, before about 20 to 24 weeks depending on how it is defined.
It is a loss whether the pregnancy was long awaited or a surprise. You may feel sad, numb, angry or guilty, and these feelings are normal.
Symptoms
The main sign is vaginal bleeding, which can be spotting, light bleeding or heavy bleeding. Other signs include:
- Cramping pain or an ache low in the tummy or back
- Pink, grey or white lumps, or clot-like material, passing from the vagina
- A gush or leak of fluid
- No symptoms at all (a missed miscarriage, found at a scan)
Bleeding and tummy pain in pregnancy can have other causes, and many women who spot in early pregnancy do not miscarry.
When to see a doctor
If you are pregnant and have any bleeding, contact your doctor or an early pregnancy unit, even if it is light. Unusual discharge or leaking fluid also needs advice.
After a miscarriage, get help urgently if you develop a fever, foul-smelling or pus-stained discharge or severe tummy pain, which can be signs of infection.
Causes
Most miscarriages are linked to a problem in the way the baby is developing, very often a chromosome problem. In many cases no cause can be found. Other known causes include problems with the womb, cervix or placenta, and some health conditions. Ordinary daily activity is not among them.
Risk factors
- Age: the chance rises with the mother's age, especially from 35
- Having had a miscarriage before
- Diabetes that is not well controlled, PCOS, a thyroid problem or a blood clotting condition
- A problem with the womb
- Smoking, alcohol and a lot of caffeine
- Being very overweight or underweight
Complications
Serious physical complications are rare. They can include:
- Infection, if some pregnancy tissue stays in the womb
- Grief, low mood and anxiety, which can last longer than the physical recovery
- Repeated losses (three or more), which are a reason for tests
Prevention
Many miscarriages cannot be prevented. Starting antenatal care early, not smoking, avoiding alcohol, limiting caffeine, keeping to a healthy weight and keeping conditions such as diabetes and thyroid problems under control before and during pregnancy all help.
Diagnosis
The doctor will ask about this pregnancy, earlier pregnancies and your health. The usual test is an internal (transvaginal) scan, which shows what is happening in the womb. Blood or urine tests may be done as well.
Treatment
A miscarriage cannot be stopped once it has started. Treatment helps your body and keeps you safe. For an early miscarriage the options are:
- Waiting: no treatment while the symptoms pass, usually about two weeks but sometimes longer
- Medicine: tablets that help the pregnancy pass, at home or in hospital
- A short procedure: gentle suction through a thin tube to empty the womb, under local or general anaesthetic, often with same-day discharge
A later miscarriage may mean giving birth, with labour starting on its own or with medicine, and the care team supports you through it. If your blood group is rhesus (D) negative and you were 12 weeks or more pregnant, you may be offered an anti-D injection.
Afterwards, expect tummy pain for a few days and bleeding or spotting for up to two weeks. Paracetamol can help the pain. Avoid sex until the symptoms have gone, because of the risk of infection. You can try again when you feel ready and the symptoms have gone. Talk to people you trust, and ask about counselling.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“A miscarriage happens because of something the mother did, such as lifting, working, exercise, stress or eating certain foods.”What is true?
Fact
Most miscarriages are linked to the baby not developing as it should, very often because of a chromosome problem, and in many cases no cause is found. Ordinary daily activity is not among the known causes, and a review of trials found that low to moderate exercise in pregnancy did not raise the risk.
Myth“Bed rest or medicines can stop a miscarriage once the bleeding has begun.”What is true?
Fact
Bleeding in early pregnancy does not always mean a miscarriage, and many women who spot go on to have a healthy pregnancy. But once a miscarriage has started it cannot be stopped, so rest or medicines would not have changed it.
Myth“After a miscarriage the womb always has to be cleaned with an operation.”What is true?
Fact
Many women need no treatment: waiting is an option, and the symptoms usually pass in about two weeks, though it can take longer. Others take tablets, or have a short procedure to empty the womb through a thin tube. The right choice depends on you, how far along you were and your health.
Myth“One miscarriage means you will keep losing pregnancies, or that you cannot have children.”What is true?
Fact
Most women who have had a miscarriage go on to have a successful pregnancy. Tests and support are advised after three or more miscarriages, because a cause that can be treated may be found.
Myth“It was only an early pregnancy, so it should not be talked about or grieved over.”What is true?
Fact
Losing a pregnancy is a real loss at any stage, and a range of feelings is normal. Emotional recovery can take longer than physical recovery. Talking to your partner, family or friends, or having counselling, can help, and partners may need support too.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Was it my fault?
Most miscarriages are linked to a problem in how the baby was developing, very often a chromosome problem, and a miscarriage cannot be stopped once it has started. Feeling guilty is common, but it does not mean you did anything wrong. If you would like to talk it through, ask your doctor.
How long will the bleeding last?
Expect tummy pain for a few days and bleeding or spotting for up to two weeks. Your next period may take up to eight weeks, and cycles can take a few months to settle. Contact a doctor if you are worried about your symptoms.
When can I try again?
You can try for another pregnancy when you feel ready and your symptoms have gone. Most women who have had a miscarriage go on to have a successful pregnancy. If you have had three or more miscarriages, see a doctor about tests.
Is it normal to feel so low afterwards?
Yes. Many people feel sad, empty or guilty, and emotional recovery can take longer than physical recovery. If the sadness does not ease or gets worse, talk to a doctor, and if you ever have thoughts of harming yourself, get help straight away from a doctor, a family member or an emergency service. Partners may need support too.