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Miscarriage

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

Miscarriage is very common, and occurs in about one in four pregnancies although there is some evidence to show that it may affect nearly one in three. Most happen in the first 12 weeks of pregnancy.

Recurrent miscarriages are when you lose three or more pregnancies in a row. This is uncommon and affects only one in every 100 couples.

Often no cause can be found for a miscarriage or recurrent miscarriages. Most women go on to have a successful pregnancy in the future.

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  • Types Types of miscarriage

    There are several different types of miscarriage.

    • Threatened miscarriage. This is when you have bleeding early in your pregnancy and your cervix (the opening to your womb) is tightly closed. In about half of all women who have a threatened miscarriage the pregnancy continues successfully.
    • Inevitable miscarriage, usually just called a miscarriage. This is when you have bleeding early in your pregnancy and your cervix is open, which means your pregnancy will be lost.
    • Incomplete miscarriage. This is when you have had a miscarriage but there is still some tissue left in your womb.
    • Complete miscarriage. This means that you have lost your pregnancy and your womb is empty.
    • Delayed, missed or silent miscarriage. This means that although your developing baby has died, you haven’t had any bleeding or lost any tissue. See our frequently asked questions for more information.
  • 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 or even weeks. There is some evidence that the heavier the bleeding, the greater the risk of an inevitable miscarriage. You may also see blood clots or a brown discharge.

    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, although sometimes there will be a reduction in the symptoms of pregnancy. 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, he or she is likely to arrange for you to go directly to hospital.

    Alternatively, 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 show if you have had a complete or incomplete miscarriage. A very early pregnancy may not show up on the scan.
    • 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 is causing your bleeding.

    Recurrent miscarriages

    If you have recurrent miscarriages, your GP may do some blood tests and may arrange for you to have an ultrasound scan. He or she 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. Sometimes no reason can be found and it’s possible that a number of factors are involved. As well as the causes of miscarriage previously described, recurrent miscarriage may happen because of a problem with your immune system. This causes your body to react in the wrong way to your developing baby. However, more research is needed to confirm this.

  • Treatment Treatment of miscarriage

    If you have a complete miscarriage, 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. You probably won't need any other treatment but you may need to wear sanitary protection until the bleeding stops.

    If you have an incomplete or missed miscarriage or there is a lot of bleeding, you may need treatment with medicines or surgery to remove the remaining fetal tissue. However, if your doctor thinks it’s safe for you to do so, you may prefer not to have any treatment and let nature take its course (this is called expectant management).

    Your chance of having a healthy pregnancy in the future is just as good whichever method you choose.

    Expectant (conservative) management

    This is when your pregnancy is allowed to leave your body naturally. It can take some time before any bleeding starts and it’s usual for this to continue for several weeks. You may also have abdominal cramps but if these become severe or 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 may need to take medicines or have surgery if expectant management isn’t successful.

    Medicines

    You may wish 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 or a pessary that is inserted directly into your vagina, or you may have both. The effects of the medicines usually begin within a few hours, and will lead to symptoms similar to a heavy period, including bleeding and abdominal cramps. The bleeding can continue for several weeks.

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

    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. You may be advised to have surgery if you have developed an infection.

    Surgery for miscarriage is a short procedure to empty your womb. It's known as an evacuation of retained products of conception (ERPC). Your doctor will pass a soft, plastic tube through your cervix into your womb and the remaining tissue will be removed by suction. The procedure takes about five to 10 minutes.

    The procedure is usually done as a day case under general anaesthesia, which means you will be asleep during the operation. You may also be able to have a similar procedure called manual vacuum aspiration. This is done under local anaesthesia in an outpatient department.

    As with every procedure, there are some risks associated with ERPC. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you. Complications are when problems occur during or after the procedure. Specific complications of ERPC include:

    • excessive bleeding
    • infection
    • a perforation or small hole made in your womb during the procedure – you may need further surgery to repair this
    • Asherman’s syndrome – this is when there is damage to the lining of your womb that causes the walls to stick together

    Ask your doctor to explain these risks to you.

    After the operation 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, it’s important to contact your GP or early pregnancy assessment unit as soon as possible.

    Late miscarriages

    If you have a miscarriage between 14 and 24 weeks, you will probably have to go through labour and delivery. The miscarriage may occur naturally or you may need to take medicines to start labour. You will probably have some bleeding and abdominal cramps similar to period pain afterwards, which may last for several weeks. You may feel very tired and emotional and your breasts may feel painful and produce milk. You may wish to take over-the-counter painkillers but if you feel very uncomfortable, speak to your GP or midwife who 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 but a post-mortem may provide information that will help medical staff to care for you if you have a future pregnancy.

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  • After a miscarriage 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 will need to wear sanitary protection while you’re bleeding. Your periods should return to normal within about three to eight weeks later but it may take several months to get back into a regular pattern. 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 have 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. It’s common for women to recover from the physical effects of a miscarriage more quickly than the emotional impact. Every woman reacts differently and there is 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. You could consider contacting support groups where you can talk with people who may have similar experiences to you.

    If you had surgery to treat your miscarriage, speak to your nurse or doctor about what will happen to the remaining fetal tissue. If you had a late miscarriage, it may be possible for you to hold your baby. You may 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. He or she may recommend that you wait until you have had at least one period before trying again. This is because your first menstrual cycle after a miscarriage may be irregular and not because there is any increased risk of having another miscarriage if you get pregnant during this time. It isn’t possible to say for certain whether you will have another miscarriage, but most women go on to have a successful pregnancy.

  • Causes Causes of miscarriage

    There are likely to be a number of reasons why you have a miscarriage, but up to nine out of 10 early miscarriages happen because of an abnormality with your developing baby. This is probably a result of a problem with the genetic material (chromosomes). Often it isn’t possible to find out why this happened.

    Most miscarriages that happen in the second trimester (between 13 and 27 weeks of pregnancy) are caused by something that affects the mother. These include:

    • your age – half of all pregnancies in women over the age of 45 end in miscarriage
    • health problems, such as poorly controlled diabetes, kidney disease or polycystic ovary syndrome
    • smoking or taking illegal drugs
    • drinking alcohol while you're pregnant
    • problems with your immune system
    • a physical problem with your reproductive system
    • treatment for cervical cancer
    • having an infection, such as listeria, malaria or rubella (German measles)

    Some research suggests that taking non-steroidal anti-inflammatory drugs (NSAIDs) may increase your risk of having a miscarriage. However, it’s not clear whether this is because of the medicines themselves or the condition that they are being used to treat.

    It’s possible that certain herbal remedies, including aloe vera and bitter lemon, may increase your risk of a miscarriage, but more research is needed to confirm this.

    There isn't any evidence to show that stress is a risk factor for miscarriage, but it's a good idea to take time to relax. Moderate exercise or having sex while you're pregnant doesn't increase your risk of miscarriage.

    Often you won't know what has caused your miscarriage. If you have already started to miscarry, there is nothing that can be done to prevent it.

  • Prevention Prevention of miscarriage

    It isn’t possible to prevent miscarriage but there are certain things that increase your risk of having one. You can help to reduce your risk of pregnancy problems by eating a healthy, balanced diet, losing excess weight and not drinking too much alcohol or smoking. It’s important that you’re already taking these steps before you become pregnant as well as following them during your pregnancy. See our frequently asked questions for more information.

  • FAQs FAQs

    Did my miscarriage happen because of something I did?

    Answer

    It's very unlikely that your miscarriage was a result of anything you did. Miscarriages are very common and the things that most often cause them can't be prevented.

    Explanation

    It's very unlikely that your miscarriage happened because of something you did. 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.

    Although there are certain things that increase your risk of miscarriage, such as smoking, there are others that have been found not to. These include:

    • being under stress
    • doing moderate exercise during pregnancy
    • having sex during pregnancy

    Is there anything I can do to reduce my risk of having a miscarriage?

    Answer

    Most miscarriages are the result of a genetic abnormality that happens by chance when your baby is developing. This means that they can’t be prevented. However, there are a number of things you can do to reduce your risk of having one.

    Explanation

    If you drink alcohol heavily, you’re at an increased risk of a miscarriage if you become pregnant. More evidence is needed about the possible harm drinking during pregnancy may cause to your unborn baby. It’s known that drinking heavily while pregnant can be damaging. Therefore, it’s recommended that you don’t drink alcohol if you’re pregnant. This is especially important during the first trimester when there is a greater risk of miscarriage.

    If you choose to drink alcohol during pregnancy, don’t have more than one to two units once or twice a week. One unit is equal to half a pint of ordinary strength lager or beer or one shot (25ml) of spirits. A small glass (125ml) of wine is equal to one and a half units. Don’t get drunk or binge drink while you're pregnant, as this can be harmful to your baby.

    Listeriosis is an illness with mild, flu-like symptoms that can be caused by listeria bacteria in certain foods. Listeriosis can cause a miscarriage if you get it during the first three months of pregnancy. To reduce your risk of a listeria infection, don’t eat or drink:

    • milk that isn't pasteurised or UHT
    • ripened soft cheese made with unpasteurised milk, such as Camembert, Brie and blue-veined cheese
    • pâté (any type, including vegetable pâté), cold meat, smoked fish or seafood
    • ready-made meals that have been cooked and refrigerated for a while before they are eaten

    It's safe for you to eat hard cheeses (such as Cheddar), cottage cheese and processed cheese.

    If you’re pregnant and get malaria, this can increase your risk of a miscarriage. 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.

    Smoking can also increase your risk of a miscarriage. If you smoke, you should stop before you try to get pregnant.

    When can I try for another baby after a miscarriage?

    Answer

    You will probably ovulate in the first month after a miscarriage so it’s possible that you could become pregnant during this time. However, it may take longer than this for you and your partner to feel ready to try for another baby.

    Explanation

    Most miscarriages occur as a one-off event and there is a good chance you will 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 is a risk of infection. He or she 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 have 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.

    It may take several menstrual cycles to get back into a regular pattern. You will be producing eggs during this time so if you don't want to get pregnant, you will need to use contraception.

    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 is 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.

    Can having a stitch in my cervix reduce my risk of having a miscarriage?

    Answer

    If you're at a high risk of a late miscarriage and tests have found that you have a weakness in your cervix (neck of your womb) that causes it to dilate (open) too soon, your doctor may suggest that you have a procedure called a cervical suture or cerclage. This will help to keep your cervix closed during your pregnancy and may reduce your risk of a miscarriage.

    Explanation

    The cervix usually stays tightly closed during pregnancy. Occasionally it starts to open early, leading to a miscarriage. If you have a miscarriage in the second or third trimester of pregnancy, this may indicate that you have a weakness in your cervix that causes it to dilate too soon. Your cervix may have been weakened as a result of surgery or damage to it caused by a previous difficult birth. Having a cervical stitch may reduce your risk of a miscarriage.

    The operation involves stitching a tape or thread around your cervix. This will give it more support and help to keep it closed during your pregnancy. The cervical stitch can be inserted at different places around your cervix. Your gynaecologist (a doctor who specialises in women’s reproductive health) can give you more information and will advise you which type is most suitable for you.

    You will probably have the operation after 12 weeks of pregnancy. Depending on which type you have, you may have it done through your vagina or your abdomen (tummy) – this may be open or keyhole surgery. The procedure may be carried out under local or general anaesthesia. A cervical stitch can also be used before you get pregnant or in an emergency situation if you appear to be at risk of having a miscarriage.

    You may or may not have the stitch removed before giving birth – this depends on which type you have. If you have the stitch removed, this will be done after about 37 weeks. If the stitch isn’t taken out, you will have to give birth by caesarean. Otherwise you should be able to give birth normally.

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

    There isn’t much evidence about cervical weakness or about the safety and effectiveness of a cervical stitch. Therefore, it’s important to talk to your doctor about the procedure and make sure that you understand its limitations as well as the possible benefits.

    What is a missed miscarriage? Is it really a miscarriage?

    Answer

    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 have had a miscarriage until you have a routine scan.

    Explanation

    A missed miscarriage is also known as a delayed or silent miscarriage.

    If you have a missed miscarriage, you may continue to have pregnancy symptoms, such as sickness, because pregnancy hormones are still being produced by the placenta. Many women who have a missed miscarriage only find out during a routine scan.

    Some women do have symptoms, and these can include:

    • decreasing pregnancy symptoms
    • discharge from your vagina – this may be brown at first becoming bright red later on

    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 recommend medicines or surgery to remove the tissue. However, you may prefer to wait for your womb to get rid of the fetal tissue, which is called expectant (or conservative) management.

  • Resources Resources

    Further information

    Sources

    • Recurrent and late miscarriage: tests and treatment of couples. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published May 2012
    • Miscarriage. BMJ Best Practice. www.bestpractice.bmj.com, published November 2012
    • Miscarriage. Tommy’s. www.tommys.org, published December 2012
    • Murphy F, Jones E, Horsley S. Miscarriage and ectopic pregnancy 1: an overview. Nurs Times 2008; 104(22):22–23. www.nursingtimes.net
    • Miscarriage signs and symptoms. National Childbirth Trust. www.nct.org.uk, accessed 3 May 2013
    • Early pregnancy loss in emergency medicine. eMedicine. www.emedicine.medscape.com, published September 2011
    • Miscarriage. American Pregnancy Association. www.americanpregnancy.org, published November 2011
    • Miscarriage. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published February 2010
    • Green top guideline no. 54A. The prevention of malaria in pregnancy. Royal College of Obstetricians and Gynaecologists. www.nathnac.org, published April 2010
    • Cervical cancer and pregnancy. Cancer Research UK. www.cancerresearchuk.org, published September 2012
    • Your miscarriage: a leaflet with pictures. The Miscarriage Association. www.miscarriageassociation.org.uk, published 2010
    • Information. The Miscarriage Association. www.miscarriageassociation.org.uk, published October 2010
    • After a miscarriage: physical recovery. American Pregnancy Association. www.americanpregnancy.org, published January 2013
    • hCG test. The Association for Clinical Biochemistry. www.labtestsonline.org.uk, published October 2011
    • Alcohol and reproduction. Drinkaware. www.drinkaware.co.uk, published May 2013
    • While you’re pregnant – listeria. US Food and Drug Administration. www.fda.gov, published October 2011
    • Listeria. Health Protection Agency. www.hpa.org.uk, published May 2011
    • Listeria. US Department of Health and Human Services. www.foodsafety.gov, accessed 7 May 2013
    • Listeria and pregnancy. American Pregnancy Association. www.americanpregnancy.org, published June 2011
    • Smoking and reproduction. ASH. www.ash.org.uk, published February 2011
    • Keyhole surgery to stitch the cervix to prevent repeated miscarriage. National Institute for Health and Care Excellence (NICE), August 2007. www.nice.org.uk
    • Misconceptions about miscarriage. Women’s Health UK. www.womens-health.co.uk, accessed 8 May 2013
    • Missed miscarriage. Women’s Health UK. www.womens-health.co.uk, accessed 8 May 2013
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    Produced by Polly Kerr, Bupa Health Information Team, June 2013.

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