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Miscarriage

Having a miscarriage can be very distressing for you and your partner. You may be grieving for the loss of the baby you were expecting. For some, it can take weeks or months to come to terms with the loss. Speaking with a counsellor may help.

Any woman can miscarry, and often no cause can be found. However, most women go on to have a successful pregnancy in the future.

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Details

  • About About miscarriage

    A miscarriage is the unexpected loss of a pregnancy during the first 23 weeks. It happens in about one in four pregnancies. Most miscarriages happen in the first 12 weeks of pregnancy, maybe even before you know you’re pregnant.

    If you have a miscarriage, you’ll probably have vaginal bleeding and perhaps abdominal (tummy) cramps. But if you have these symptoms, it doesn’t mean that you’ll definitely have a miscarriage.

  • Types Types of miscarriage

    You may hear lots of different phrases used to describe miscarriages:

    Different phrases used to describe miscarriages

    Here we go through them to let you know what they all mean.

    A threatened miscarriage is when you have bleeding, with or without abdominal (tummy) pain, early in your pregnancy. It may be the start of a miscarriage, or your pregnancy may continue.

    When there are signs that you are definitely having a miscarriage and that the pregnancy has ended, doctors call this an inevitable miscarriage. You may have heavy blood clots, and pain.

    When there are signs that you’re definitely miscarrying and your pregnancy cannot continue, it may be described as either incomplete or complete. An incomplete miscarriage is when you’ve had a miscarriage but there’s still some tissue left in your womb. A complete miscarriage means that your womb is empty.

    You may have a miscarriage which is called delayed, missed or silent. This means that although your developing baby has died, you haven’t had any bleeding or lost any tissue. See our frequently asked questions below for more information.

    An early miscarriage happens in the first trimester, before the end of the 13th week. A late miscarriage happens in the second trimester, from week 14 to the end of week 23. Recurrent miscarriages, which affect one in every 100 couples, are when you lose three or more pregnancies in a row.

    You may occasionally see or hear a miscarriage referred to as a spontaneous abortion. This is the medical term for miscarriage. The use of the word abortion here doesn’t mean that the mother has made a decision to end the pregnancy.

  • Symptoms Symptoms of miscarriage

    The most common symptom of a miscarriage is bleeding from your vagina when you’re pregnant. This can vary from light spotting to very heavy bleeding and may go on for several days. You may also see blood clots. If your bleeding increases or becomes heavier than a normal period, then a miscarriage may be more likely.

    You may have painful cramps in your abdomen (tummy). These can spread to your pelvis and back.

    It’s possible that you won’t have any symptoms, especially with a delayed miscarriage. You may, in this case, notice that any symptoms of pregnancy that you had have lessened, or gone. You may only find out that you have had a miscarriage when you go for a routine scan.

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

  • Diagnosis Diagnosis of miscarriage

    Your GP will ask about your symptoms and examine you. If your bleeding is very heavy or you’re in pain, they’re likely to arrange for you to go directly to hospital.

    Your GP may refer you 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. This test is usually the best way to check if your pregnancy is developing or if there’s a miscarriage. If you’ve had a miscarriage, this test will also show whether there’s still tissue in your womb. A very early pregnancy may not show up on the scan and you may need to have a repeat scan after another week or so.
    • Blood and urine tests can measure hormones (chemicals) associated with pregnancy called beta-human chorionic gonadotrophin and progesterone.
    • Your doctor may need to examine your vagina and womb to find out what’s causing your bleeding.

    Recurrent miscarriages

    The term recurrent miscarriage is used when you’ve had three or more miscarriages, one after the other. If you have recurrent miscarriages, your GP may do some blood tests and may arrange for you to have an ultrasound scan. They may refer you and your partner to a gynaecologist (a doctor who specialises in women’s reproductive health) for further tests to rule out a specific cause. Often no reason can be found for recurrent miscarriages.

  • Management Managing an early miscarriage

    If you’ve had a miscarriage, your healthcare team can help you get through this unpleasant experience as safely and as comfortably as possible. It’s normal to feel distressed, anxious and very sad after a miscarriage. Speak to your GP about this – they can arrange for counselling or further help if you need it.

    We describe here how your miscarriage may be managed to help your body recover.

    In some cases of miscarriage your womb has emptied itself by the time you seek medical help and have tests (a complete miscarriage). If so, you don’t need any further specific medical management.

    If your tests show that there’s still some tissue in your womb (an incomplete miscarriage), there are a number of options for what happens next. You may prefer not to have any treatment and let nature take its course (this is called expectant management). Or you may choose to have medicines or a surgical procedure. Ask your doctor to explain these options, and discuss what might be best in your circumstances. Your chance of having another baby is likely to be just as good whichever method you choose.

    Whatever course your miscarriage takes, you’ll need to wear sanitary pads until the bleeding stops. Don’t use tampons as these may increase your risk of infection. If you have pain, you may wish to take over-the-counter painkillers such as paracetamol. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist.

    Expectant (conservative) management

    This is when your pregnancy is given time to leave your body naturally. You’re likely to have period-like abdominal cramps and you may pass clots. If you develop symptoms such as fever or vaginal discharge that smells unpleasant, it’s important to contact your GP or early pregnancy assessment unit. You can also contact them if you’re finding the symptoms too difficult to cope with.

    You may need to take medicines or have surgery if expectant management isn’t successful.

    Medicines

    You may choose to take medicines that will open your cervix and allow fetal tissue to pass out. These may be in the form of tablets to take by mouth and/or a pessary that is inserted directly into your vagina. The medicines will lead to symptoms similar to a heavy period, including bleeding and abdominal cramps. The bleeding can continue for several weeks. The medicines may also make you feel sick.

    To help you cope with your symptoms, your doctor will offer you painkillers and medicines to stop you feeling sick. Carefully read the patient information leaflet that comes with any medicines you’re taking.

    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, how much bleeding you're having and your own preferences. Your doctor will probably recommend surgery if you have developed an infection.

    Your doctor may offer you a choice of procedures to remove the tissue from your womb. These are:

    • Surgical removal, in an operating theatre under general anaesthesia. You’ll be asleep during the procedure.
    • Vacuum removal (aspiration), in an outpatient clinic under local anaesthesia. You’ll be awake during the procedure, but the pain from your womb area will be blocked.

    If you choose to have surgery, your doctor will discuss the details with you and answer any questions you have.

    After the procedure you’re likely to have bleeding for several weeks and you may have abdominal cramps for a few days. If the bleeding becomes severe or you develop symptoms, such as a fever or vaginal discharge that smells unpleasant seek medical advice. It’s important to contact your GP or early pregnancy assessment unit as soon as possible.

  • Late miscarriage Having a late miscarriage

    A late miscarriage is one that happens between 14 and 23 weeks of pregnancy – it’s also known as a second-trimester miscarriage. If you have a late miscarriage, this will probably be a very sad and difficult time for you. Your hospital team will understand this, and do all they can to support you through the process.

    If your baby has died and still lies inside your womb, you’ll probably have to go through labour and delivery. The miscarriage may occur naturally or you may need to take medicines to start labour. You may be able to hold your baby after the delivery if you wish, or you may choose not to. There’s no right or wrong decision – it’s up to you. Talking to your doctor or nurse about it may help you decide.

    Afterwards you’ll probably have some bleeding and abdominal cramps similar to period pain, which may last for several weeks. You may feel very tired and emotional. Your breasts may feel painful and produce milk, which you may find upsetting. You can take over-the-counter painkillers, but if you feel very uncomfortable, speak to your GP or midwife. They may be able to prescribe medicines to reduce how much milk your breasts produce.

    It may be possible to have a post-mortem on your baby to try to find out what caused the miscarriage. It isn’t always possible to find a reason for a miscarriage. However, a post-mortem may provide information that will help medical staff to care for you if you have a future pregnancy.

    Some people find it difficult to accept that losing a baby as late as 23 weeks is called a miscarriage, not a stillbirth. But this is because 24 weeks is the legal age of viability (the age when a baby may survive outside the womb). It doesn’t mean that losing your baby before this stage is any less important to you.

  • After a miscarriage After a miscarriage

    Having a miscarriage affects women in different ways. You may recover from the physical effects of a miscarriage more quickly than the emotional impact. Every woman reacts differently and there’s no right or wrong way to feel. It can be a difficult time for your partner too and it’s important that you both get the support you need. Your GP can discuss things with you and may be able to advise you where you can get further support. Support groups where you can talk with people, who may have similar experiences to you, may help.

    Your body needs time to recover after a miscarriage. It may take several weeks for the physical effects of a miscarriage to clear up. You can take over-the-counter painkillers to help relieve abdominal cramps and you’ll need to wear sanitary pads while you’re bleeding. Don’t use tampons as these may increase the risk of infection. Your periods should return to normal within about three to eight weeks. After a miscarriage your breasts may produce milk and there will still be some pregnancy hormones in your body. This can last for several weeks and a pregnancy test may still produce a positive result during this time even though you’ve had a miscarriage.

    The time it takes for you to feel ready to return to your usual activities, such as exercising and going back to work, will vary for every woman. Your doctor can give you advice about this.

    If you passed your pregnancy in hospital or had surgery to treat your miscarriage, your nurse or doctor can advise what options there are for the remaining fetal tissue (this is likely to be a burial or cremation). If you had a late miscarriage, it may be possible for you to hold your baby. You may also wish to consider having a memorial service, burial or cremation. Staff at the hospital can give you advice and information about these options.

    You may decide to begin trying for another baby right away or you may feel you need time 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. Your doctor is likely to advise you not to have sex until your bleeding has stopped to reduce your risk of developing an infection. They may recommend that you wait until you have had at least one period before trying again. It isn’t possible to say for certain whether you’ll have another miscarriage, but most women go on to have a successful pregnancy. See our FAQ below on getting pregnant again after miscarriage.

  • Causes Causes of miscarriage

    Often you won't know what has caused your miscarriage. Most early miscarriages happen because your baby isn’t developing normally right from the start. This is probably a result of a problem with the genetic material (chromosomes). We don’t know why this happens, but it’s more common in older mothers.

    The reason for a late or recurrent miscarriage may not be found. There are a number of factors affecting the mother which may play a part. These include:

    • your age. The older you are the higher your risk of miscarriage. Half of all pregnancies in women over the age of 40 end in miscarriage
    • antiphospholipid syndrome (APS) and thromobophilia – medical conditions which make your blood more likely to clot
    • health problems, such as poorly controlled diabetes or thyroid problems
    • problems with your immune system
    • a physical problem with your reproductive system
    • fibroids – benign growths in your womb (uterus)
    • treatment for cervical cancer
    • having an infection. Any infection that makes you very unwell, or a milder infection that affects your baby, can cause a miscarriage

    There are some factors that increase your risk of miscarriage that you can improve by making healthy lifestyle choices. Miscarriages are more likely if you are overweight, you smoke or take illegal drugs, or if you drink five or more units of alcohol a week. See our section on prevention of miscarriage below for more information.

  • Prevention Prevention of miscarriage

    Most miscarriages can’t be prevented. However, there are a number of things you can do to reduce your risk of having a miscarriage and increase your chance of having a healthy baby.

    • Limit the amount of alcohol you drink. Doctors now recommend that you don’t drink any alcohol at all while you’re pregnant, or planning to become pregnant. The more you drink, the greater the risk to your baby.
    • Give up smoking, and don’t use illegal drugs if you’re pregnant or planning to become pregnant. Smoking in pregnancy is harmful to you and your baby.
    • Eat a healthy balanced diet. Avoid certain foods that may increase your risk of miscarriage. These include unpasteurised dairy products, blue cheeses, and raw eggs. Ask your midwife or GP for a full list of foods to avoid in pregnancy and see our topic healthy eating during pregnancy for more details.
    • Being a healthy weight. If you are underweight or overweight, this can increase your chance of miscarriage. You can use our body mass index (BMI) calculator to check.
    • Try to avoid infections which might harm your baby, such as malaria. 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 go.

    It may be that your doctor has found a cause for your miscarriage, and that treatment may help you avoid further miscarriages. This might be the case if you have a condition called antiphospholipid syndrome (APS) which can be treated with medicines. If you have a weakened cervix, which can cause miscarriages, then your doctor may offer you a procedure called a cervical stitch. See our FAQ below for more information.

  • FAQ: Feelings of guilt after miscarriage Did my miscarriage happen because of something I did?

    It’s not unusual to have feelings of guilt when you have a miscarriage. But it's very unlikely that your miscarriage happened because of something you did, or didn’t do. Miscarriages are very common and the things that most often cause them can't be prevented. The main cause of miscarriage is a genetic abnormality that occurs in your developing baby. This is often a result of chance so there is nothing you can do to prevent it. See our section on causes of miscarriage above for more information.

    There are lots of things that people may worry about during pregnancy, but that don’t seem to cause miscarriage. These include exercise, working long hours, heavy lifting, sex, and travelling by air. Women who are under stress during pregnancy may have a higher risk of miscarriage, but we don’t know if it’s the stress alone which causes it.

    If you are worried that something you did caused your miscarriage, speak with your GP or midwife so that they can reassure you.

  • FAQ: Getting pregnant again When can I try for another baby?

    You may want to try for another baby again as soon as possible, or you may feel you need a break before becoming pregnant again. The best advice is usually to avoid having sex until your bleeding stops. And then to wait until you have one period before you try to get pregnant. However, it may take longer than this for you and your partner to feel ready to try for another baby.

    More information

    Most miscarriages occur as a one-off event and there’s a good chance you’ll have a successful pregnancy in the future. Your doctor will advise you to wait until you have no more bleeding before you start to have sex again, otherwise there’s a risk of infection. They may recommend that you wait until you have had a period before trying to get pregnant again. This is because your first menstrual cycle after a miscarriage may not be the same length as usual. This can make it difficult to work out when conception happened if you do become pregnant during this time.

    If you’ve had recurrent miscarriages and have had tests to try to find out why, it’s a good idea to wait until you have the results of these before trying to get pregnant again.

    If you don’t wish to become pregnant, you’ll need to use contraception from immediately after your miscarriage.

    Losing a pregnancy is a deeply personal experience that affects everyone differently. It can affect you, your partner and other members of your family. There’s no right or wrong time to start trying for another baby if you decide that this is what you want. If you have any concerns about trying for another baby, it may help to talk to your GP or a counsellor.

  • FAQ: Cervical stitch (suture, cerclage) My doctor has recommended I have a stitch in my cervix – what happens?

    A cervical stitch is a procedure where your doctor places a stitch (suture) around the neck of your womb (cervix). They may offer to do this if you're at a high risk of a late miscarriage and you’ve been found to have a weakened cervix. This procedure will help to keep your cervix closed during your pregnancy and may reduce your risk of a miscarriage.

    More information

    The cervix usually stays tightly closed during pregnancy. In some women it starts to open early, leading to a miscarriage. Or your cervix may have been weakened as a result of surgery or damage to it caused by a previous difficult birth. The cervical stitch procedure (also called cervical cerclage) involves stitching a suture or thread around your cervix. This gives it more support and helps to keep it closed during your pregnancy.

    You’ll probably have the operation at about 12–14 weeks of pregnancy. It’s done in a hospital operating theatre. You may have the procedure with a general anaesthetic, where you are asleep. Or you may have spinal anaesthesia which means you are awake but numb from the waist down. Your doctor will discuss with you which is best in your circumstances. You may be able to go home the same day, or you may have to stay overnight.

    Your stitch will usually be removed in hospital at about 36–37 weeks if you haven’t already gone into labour by then. If you go into labour while the stitch is in, it will need to be removed quickly. If you have a stitch and think you’re in labour, contact your maternity unit right away.

    There are some risks associated with having a cervical stitch inserted, such as bleeding, infection and miscarriage. Your doctor will explain these to you.

    Putting in a cervical stitch doesn’t always work to prevent miscarriage if you have a weakened cervix. Talk to your doctor to make sure you understand how it might help in your circumstances.

  • FAQ: Missed miscarriage Is a missed miscarriage really a miscarriage?

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

    You may still feel pregnant, and a pregnancy test may still be positive. However, you may have noticed that your pregnancy symptoms have decreased. Some women with a missed miscarriage recall that they’ve had a brownish vaginal discharge at some point.

    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 offer you medicines or surgery to remove the tissue. Or you may prefer to wait for your womb to get rid of the fetal tissue, which is called expectant (or conservative) management. See our section on treatment of miscarriage above for more information.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Miscarriage. BMJ Best practice. bestpractice.bmj.com, last updated March 2016
    • Miscarriage (spontaneous abortion). PatientPlus. patient.info/patientplus, last checked February 2013
    • Spontaneous abortion. The MSD Manuals. www.msdmanuals.com, last full review/revision January 2014
    • Miscarriage. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised July 2013
    • Map of Medicine. Miscarriage. International View. London: Map of Medicine; 2013 (Issue 2)
    • Early pregnancy loss in emergency medicine. Medscape. www.emedicine.medscape.com, updated November 2015
    • Early pregnancy loss. Medscape. www.emedicine.medscape.com, updated November 2015
    • Recovering from surgical management of a miscarriage. Royal College of Obstetricians and Gynaecologists, 2015. www.rcog.org.uk
    • Recurrent and late miscarriage. Royal College of Obstetricians and Gynaecologists, 2012. www.rcog.org.uk
    • Smoking and pregnancy. Royal College of Obstetricians and Gynaecologists, 2015. www.rcog.org.uk
    • Cervical suture. Royal College of Obstetricians and Gynaecologists, 2014. www.rcog.org.uk
    • Thinking about another pregnancy. The Miscarriage Association. www.miscarriageassociation.org.uk, accessed May 2016
    • Management of miscarriage: your options. The Miscarriage Association. www.miscarriageassociation.org.uk, accessed May 2016
    • Late miscarriage: second trimester loss. The Miscarriage Association. www.miscarriageassociation.org.uk, accessed May 2016
    • Your feelings after miscarriage. The Miscarriage Association. www.miscarriageassociation.org.uk, accessed 1 May 2016
    • Why me? The Miscarriage Association. www.miscarriageassociation.org.uk, accessed May 2016
    • Recurrent miscarriage. The Miscarriage Association. www.miscarriageassociation.org.uk, accessed May 2016
    • About the cervical stitch. The Miscarriage Association. www.miscarriageassociation.org.uk, accessed May 2016
    • After a miscarriage. American Pregnancy Association. www.americanpregnancy.org, last updated August 2015
    • hCG test. The Association for Clinical Biochemistry & Laboratory Medicine. www.labtestsonline.org.uk, last reviewed December 2013
    • Cervical cancer and pregnancy. Cancer Research UK. www.cancerresearchuk.org, updated June 2014. www.nice.org.uk
    • UK Chief Medical Officers’ Alcohol Guidelines Review summary of the proposed new guidelines. Department of Health, 2016. www.gov.uk
    • Green top guideline no. 54A. The prevention of malaria in pregnancy. Royal College of Obstetricians and Gynaecologists. www.nathnac.org, published April 2010
    • Early pregnancy loss. Medscape. reference.medscape.com, updated November 2015
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