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Miscarriage


Expert reviewer, Dr Samantha Wild, General Practitioner, Bupa UK
Next review due December 2021

A miscarriage is the loss of a pregnancy during the first 23 weeks. Most miscarriages happen in the first 12 weeks of pregnancy, often before you even know you’re pregnant.

If you have a miscarriage, you’ll probably have vaginal bleeding and sometimes abdominal (tummy) cramps. But these symptoms can be common in early pregnancy so it doesn’t mean you’re definitely having a miscarriage.

Having a miscarriage can be really distressing for you and your partner. Being prepared for what to expect and getting the support you need, may help you to cope better with the physical and emotional effects.

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About miscarriage

Up to one in four confirmed pregnancies can end in miscarriage. However, the true rate may be higher because many pregnancies can end before the woman realises she is pregnant. Although this may sound like a lot, these figures are for all women, including those with a higher risk. Your risk also falls rapidly as you go through your pregnancy.

You may hear lots of different phrases used to describe miscarriages, Here is a list to let you know what they all mean.

  • A threatened miscarriage is when you have bleeding from your vagina, but your pregnancy may still continue.
  • An inevitable miscarriage is when there are signs that you are definitely having a miscarriage and that the pregnancy can’t continue.
  • 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 all the pregnancy tissue has been lost and your bleeding has stopped.
  • A delayed, missed or silent miscarriage means that although your developing baby has died, you haven’t had any bleeding or pain. You may only find out when you have an ultrasound scan. See our FAQs 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.

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 see blood clots. You may also have painful cramps in your abdomen (tummy). This is usually worse than the pain that you may get during your period and can spread to your pelvis and back.

Bleeding in early pregnancy doesn’t always mean that you’re having a miscarriage. But if your bleeding increases or becomes heavier than a normal period, a miscarriage may be more likely.

It’s possible that you won’t have any symptoms, if you’ve had a delayed or silent miscarriage. You may notice that any symptoms of pregnancy have lessened or stopped. You may only find out that you have had a miscarriage when you go for a routine scan.

If you have vaginal bleeding or abdominal pain at any time during pregnancy, contact your GP or midwife for advice. In some areas, you may be able to contact your local Early Pregnancy Assessment Unit directly. Some of these have walk-in clinics where you don’t need an appointment or a referral from a doctor. If you have severe symptoms such as severe pain or bleeding, you should seek urgent medical attention. This may mean going to A&E, especially if it’s at a time when other services are closed.

Diagnosis of miscarriage

If you see your GP, they may assess you and ask you to do a pregnancy test if you haven’t done one already. Depending on the result of the test and how many weeks pregnant you are, they may then refer you to a local Early Pregnancy Assessment Unit (EPAU).

At the EPAU, you’ll be offered an ultrasound scan to check if you’ve had a miscarriage. This will usually be a transvaginal ultrasound (where a small sensor is placed inside your vagina to take the scan). This ultrasound will also show if there’s still any 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.

You may sometimes be asked to have blood tests to check levels of the pregnancy hormone, beta-human chorionic gonadotrophin. You’ll usually need to have two tests, two days apart.

Recurrent miscarriages

If you’ve had three or more miscarriages in a row (recurrent miscarriages), your GP will organise for you to have some tests. These may include:

  • blood tests – these can check for blood clotting disorders and for levels of certain antibodies in your blood that may affect your pregnancy
  • scans, usually ultrasound, to check the structure of your womb
  • genetic testing of your baby, and sometimes of you and your partner

Often, no reason can be found for recurrent miscarriages. If that’s the case, you have a good chance of having a successful pregnancy in the future.

Managing an early miscarriage

You may be experiencing lots of different feelings if you’ve had a miscarriage – it’s normal to feel distressed, anxious and shocked. Your healthcare team will do their best to help you through this difficult time. You can read more about the emotional impact in our section – After a miscarriage.

Most women don’t need any medical or surgical treatment for a miscarriage – it will usually happen naturally, in its own time. If necessary, medical or surgical treatment can help speed up or finish the process. You can read more about each of these treatments below. Your doctor will help you to understand what to expect, and discuss what might be best in your circumstances. Unless you need emergency treatment, you should be given time to think about all of the options and decide what’s right for you.

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. If you develop symptoms of an infection, such as fever or vaginal discharge that smells unpleasant, contact the hospital. You should also contact them if the bleeding becomes extremely heavy or you’re finding the symptoms too difficult to cope with.

Expectant (conservative) management

This is when your pregnancy is given time to leave your body naturally. Your doctor will usually recommend trying this first, especially if you’re still in the early weeks of pregnancy. You’re likely to have period-like abdominal cramps and heavy bleeding. You may also pass some clots. However, some women don’t have much bleeding at all. If after two weeks you’re still bleeding or bleeding hasn’t yet begun, you’ll usually be offered another scan. You may decide you’d prefer medical or surgical treatment at this stage.

Medicines

Medicines can start or speed up the process of miscarriage. These may be in the form of tablets to take by mouth and/or a pessary that is inserted directly into your vagina. You’re likely to have period-like cramps and very heavy bleeding with these medicines – more than you would with a normal period. You’re also likely to pass some clots. The bleeding can continue for up to three weeks.

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

Sometimes, medical treatment doesn’t work and in this case, you may need to have surgery. You’ll be asked to do a pregnancy test three weeks after having the medicine. If it’s still positive after this time or if your bleeding gets really hard to deal with, go back to your doctor for further advice.

Surgery

You may be offered surgery to remove any tissue from your womb. This will depend on the stage of your pregnancy and how much bleeding you're having.

There are two types of procedure you may be offered.

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


Your doctor will explain exactly what happens in these procedures and answer any questions you have, before you decide whether or not to go ahead.

If you have a rhesus negative blood group, you’ll be offered an anti-D rhesus injection after your surgery. This stops your body from forming antibodies, which could be harmful to your baby if you get pregnant again.

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 or mid-trimester miscarriage. A pregnancy loss after this time is known as a stillbirth. Going through a late miscarriage can be a devastating and shocking time for any woman. Your hospital team will understand this and do all they can to support you through the process.

You will usually need to go through the process of labour and delivering your baby if you’ve had a late miscarriage. This can happen naturally or, if an ultrasound has shown that your baby has died, you may need to take medicines to start (induce) labour. You may be able to see or hold your baby after the delivery if you wish, or you may prefer 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‘re likely to feel very tired and emotional for some time.

After a miscarriage

Having a miscarriage affects women in different ways. It’ll probably take you some time to recover, both physically and emotionally.

Physical effects

It may take several weeks for the physical effects of a miscarriage to clear up. It’s normal to feel tired and run down during this time. Your periods should return to normal within about four to eight weeks.

If you’ve had a late miscarriage, your breasts may feel painful and produce milk, which can be really 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.

Emotional impact

Every woman reacts to having a miscarriage differently and there’s no right or wrong way to feel. A miscarriage can be devastating – the grief you feel can be just as intense as after any other type of major loss. It’s also perfectly normal to feel shocked, angry and numb. These feelings tend to be most intense in the first month or so after your miscarriage. In some women, they can linger on for months or even years.

It can be a difficult time for your partner too and it’s important that you both get the support you need. You should be offered a follow-up appointment with your GP or other health professional. They can talk things through with you and may be able to refer you for counselling or advise you where you can get further support.

You may decide you want to try again for a baby straight after your miscarriage or you may feel like you need more time to recover. There’s no right or wrong – it’s important that you do what’s right for you and your partner. See our FAQ on when you can try for a baby, for more information.

Your baby

If you’ve had a late miscarriage, you may be offered a post-mortem on your baby to try to find out what caused the miscarriage. It’s your decision whether or not to have this. 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.

There’s no legal requirement to have a burial or cremation when a baby dies before 24 weeks of pregnancy. But most hospitals will offer you this option or give you the choice of making your own private arrangements if you prefer. Staff at the hospital can give you advice and information about this.

Causes of miscarriage

There’s often no way of knowing what has caused your miscarriage. But it’s thought that 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).

This becomes more common as you get older, so your risk of miscarriage increases with age. Half of all pregnancies in women aged 40 to 44 end in miscarriage, compared to one in four for women aged 35 to 39.

Sometimes, a problem with the development of your placenta may lead to miscarriage. Infections such as bacterial vaginosis are often a cause of late miscarriage.

Sometimes, doctors may be able to identify a problem that may have caused you to have recurrent miscarriages. These may include the following.

  • Having antiphospholipid syndrome (APS) or thromobophilia – medical conditions which make your blood more likely to clot.
  • Having a condition that affects your hormones – for example, polycystic ovary syndrome, poorly controlled diabetes or thyroid problems.
  • Anatomical problems with your reproductive system – for example, an unusually shaped womb or a weak cervix.
  • Genetic abnormalities with you or your partner or with the developing baby.

However, a specific cause can’t be found for about half of recurrent miscarriages.

There are certain other lifestyle factors that have been shown to increase your risk of miscarriage. Miscarriages are more likely if you’re over- or underweight, if you smoke or take illegal drugs or if you drink alcohol. See our section on prevention of miscarriage for more information.

Prevention of miscarriage

Most miscarriages can’t be prevented. But there are a number of things you can do that may reduce your risk and help you to have a healthy pregnancy.

  • Limit the amount of alcohol you drink. Current advice is that it’s safest not to 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. Take care to avoid foods known to increase the risk of miscarriage. These include unpasteurised dairy products, soft and blue cheeses, and raw or undercooked meat. See our topic healthy eating during pregnancy for more details.
  • Maintain a healthy weight. If you’re 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 or travel clinic 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 about cervical stitch for more information.

Frequently asked questions

  • 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 early miscarriage is a genetic abnormality that occurs in your developing baby. This is often a random, one-off fault, 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 worry might cause miscarriage, but there is no evidence that they do. These include exercise, working long hours, heavy lifting, having sex, travelling by air and eating spicy food. 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.

    Although guidelines recommend it’s safest not to drink alcohol while you’re pregnant, if you did drink small amounts while pregnant, it’s unlikely to have caused your miscarriage.

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

  • 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. There’s no right answer – it’s very personal to you. Most miscarriages occur as a one-off event and there’s a good chance you’ll have a successful pregnancy in the future.

    It’s best to avoid having sex after a miscarriage until your bleeding stops. This is to avoid infection. Sometimes you may also prefer to wait until you’ve had a period before trying to get pregnant again. This won’t affect your chance of another miscarriage, it will just make it easier to work out how many weeks pregnant you are, if you do conceive straight away.

    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.

    Otherwise, if you feel physically and emotionally ready, there’s no medical reason why you need to wait to try again. There’s no evidence that delaying will give you a better chance of a successful pregnancy next time. In fact, there’s some evidence that you’re less likely to miscarry if you get pregnant in the first six months after a miscarriage. It’s important to make sure both you and your partner feel ready though.

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

    If you have any concerns about trying for another baby, it may help to talk to your GP or a counsellor.

  • This procedure involves your doctor placing a stitch (suture) around the neck of your womb (cervix) to help keep it closed during your pregnancy. Your doctor may offer this if you’ve had a previous miscarriage and you’ve been found to have a weakened cervix.

    Your cervix usually stays tightly closed during pregnancy. But if you have a weak cervix, it might start to open as your baby grows bigger. This may cause a miscarriage. The cervical stitch procedure (also called cervical cerclage) involves stitching a tape 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. You’ll need to go into hospital to have the procedure. It can either be done under general anaesthesia, where you’ll be asleep, or spinal anaesthesia which means you’re 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 37–38 weeks, ready for birth, if you haven’t already gone into labour. 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.

    Putting in a cervical stitch doesn’t always work to prevent miscarriage, and there are also some risks associated with having a cervical stitch. Talk to your doctor to make sure you understand how it might help in your circumstances.

  • Yes. A missed miscarriage is where your developing baby dies but stays in your womb. You may not have had any symptoms and only found out you’ve had a miscarriage when you had a routine scan – so it can come as a real shock. A missed miscarriage is also known as a delayed or silent miscarriage.

    You may still feel pregnant with a missed miscarriage, as your pregnancy hormones can continue to be high for some time afterwards. You may get a positive pregnancy test for several days or even weeks after. However, some women do notice that their pregnancy symptoms have decreased. And some recall having had a brownish vaginal discharge at some point.

    You may worry that there’s been a mistake with the diagnosis, especially if you haven’t experienced any symptoms of the miscarriage. It can make it hard to accept. Always ask the doctor if you have any questions, or if you want a repeat scan or second opinion. You will be given time to come to terms with your loss and to decide what to do.

    You can wait to see if your miscarriage happens naturally – this is called expectant (or conservative) management. If you don’t have any bleeding within a couple of weeks, you’ll be offered another scan. Your doctor may then suggest you take medicines to speed up the process or have surgery to remove the tissue. See our section on treatment of miscarriage for more information. It is important any remaining tissue is removed from your womb because it could cause an infection.


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Related information

    • The investigation and treatment of couples with recurrent first-trimester and second-trimester miscarriage. Royal College of Obstetricians and Gynaecologists, April 2011. www.rcog.org.uk
    • Miscarriage. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised May 2018
    • Miscarriage. PatientPlus. patient.info/patientplus, last checked 30 November 2016
    • Miscarriage. BMJ Best Practice. bestpractice.bmj.com, last reviewed August 2018
    • Management of miscarriage: your options. Miscarriage Association, 2016. www.miscarriageassociation.org.uk
    • Personal communication, Dr Samantha Wild, General Practitioner, Bupa UK
    • I think I'm having a miscarriage. Tommy's. www.tommys.org, last reviewed 1st August 2016
    • Ectopic pregnancy and miscarriage: diagnosis and initial management. National Institute of Health and Care Excellence (NICE), December 2012. www.nice.org.uk
    • Assessment of recurrent miscarriage. BMJ Best Practice. bestpractice.bmj.com, last reviewed August 2018
    • Recurrent miscarriage. PatientPlus. patient.info/patientplus, last checked 30 November 2016
    • Your feelings after miscarriage. Miscarriage Association, June 2014. www.miscarriageassociation.org.uk
    • Pregnancy. Oxford handbook of general practice. Oxford Medicine Online. oxfordmedicine.com, published online April 2014
    • Late miscarriage: second trimester loss. Miscarriage Association, May 2016. www.miscarriageassociation.org.uk
    • The physical process. Miscarriage Association. www.miscarriageassociation.org.uk, accessed 25 September 2018
    • UK Chief Medical Officers’ low risk drinking guidelines. Department of Health, www.gov.uk, published August 2016
    • What not to eat when pregnant. British Nutrition Foundation. www.nutrition.org.uk. January 2016
    • Diet before and during pregnancy. Oxford handbook of nutrition and dietetics. Oxford Medicine Online. oxfordmedicine.com, updated December 2015
    • Malaria and pregnancy. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published October 2014
    • Why me? Miscarriage Association, 2016. www.miscarriageassociation.org.uk
    • Thinking about another pregnancy. Miscarriage Association, 2016. www.miscarriageassociation.org.uk
    • Cervical stitch. Miscarriage Association, 2016. www.miscarriageassociation.org.uk
    • Missed miscarriage. Miscarriage Association. www.miscarriageassociation.org.uk, accessed 25 September 2018
  • Reviewed by Pippa Coulter, Freelance Health Editor, December 2018
    Expert reviewer, Dr Samantha Wild, General Practitioner, Bupa UK
    Next review due December 2021



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