Miscarriage
Your health expert: Mr Kuponiyi, Consultant Obstetrician & Gynaecologist
Content editor review by Rachael Mayfield-Blake, May 2021
Next review due May 2024
A miscarriage is the loss of a pregnancy during the first 23 weeks. Most miscarriages happen in the first 12 weeks, often before you even know you’re pregnant. A miscarriage can be distressing for you and your partner. If you’re prepared for what to expect and get the support you need, it may help you to cope.
About miscarriage
Up to one in four pregnancies end in miscarriage. But the true rate may be higher because many pregnancies end before people know they’re pregnant. Your risk of having a miscarriage falls the later you are in your pregnancy. There are different phrases used to describe the different types and stages of miscarriages – your doctor will explain these to you.
Causes of miscarriage
There’s often no way to know what caused your miscarriage. But it’s thought 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 (in weeks 13 to 23 inclusive).
A specific cause can’t be found for about half of recurrent miscarriages (when you lose three or more pregnancies in a row). But sometimes, doctors can identify something; causes include the following.
- Antiphospholipid syndrome (APS) or thrombophilia – medical conditions that make your blood more likely to clot.
- A condition that affects your hormones – for example, polycystic ovary syndrome, diabetes or thyroid problems.
- Anatomical problems with your reproductive system – for example, an unusually shaped womb or a weak cervix (the neck of your womb).
- Genetic abnormalities with you or your partner or with your developing baby.
- A vitamin D deficiency.
There are some other lifestyle things that may increase your risk of miscarriage. Miscarriages are more likely if you’re over- or underweight, smoke or drink alcohol.
Symptoms of miscarriage
The most common symptom of a miscarriage is bleeding from your vagina. 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 tummy (abdomen). This is usually worse than period pain and can spread to your pelvis and back.
Bleeding in early pregnancy doesn’t always mean that you’re having a miscarriage. But if it increases or becomes heavier than a normal period, a miscarriage may be likely.
You might not get any symptoms if you’ve had what’s called a delayed or silent miscarriage. But you may notice your pregnancy symptoms 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 tummy pain, contact your GP or midwife for advice. If you have severe pain or bleeding, seek urgent medical help.
Diagnosis of miscarriage
If you see your GP, they’ll assess you and ask you to do a pregnancy test if you haven’t done one already. Depending on the result, and how many weeks pregnant you are, they may refer you to a local Early Pregnancy Assessment Unit (EPAU).
At the EPAU, you’ll have an ultrasound scan to check if you’ve had a miscarriage and 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 a week or so.
You may need to have blood tests to check levels of the pregnancy hormone, beta-human chorionic gonadotrophin. You’ll usually have two tests, two days apart.
Recurrent miscarriages
If you’ve had three or more miscarriages in a row (recurrent miscarriages), your GP will arrange some tests and refer you to see a specialist in recurrent miscarriages. These tests may include:
- blood tests to check for blood clotting disorders and for levels of 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
Managing an early miscarriage
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.
You might not need any medical or surgical treatment after a miscarriage – it will usually happen naturally in time. You’re likely to have period-like tummy cramps and heavy bleeding. You may also pass some clots but you might not have much bleeding at all.
If you’re still bleeding or the bleeding hasn’t started after two weeks, your doctor may offer another scan, and possibly treatment. Your doctor will help you to understand what to expect, and discuss what might be best for you. Unless you need emergency treatment, you’ll have time to think about 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. Over-the-counter painkillers, such as paracetamol, will help with any pain. If you get symptoms of an infection, such as a fever or vaginal discharge that smells bad, contact your hospital. Also contact them if the bleeding becomes extremely heavy or you’re finding the symptoms too difficult to cope with.
Medicines
Medicines can start or speed up the process of miscarriage. You can take a pessary that you put into your vagina and/or tablets. 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 so your doctor may offer you painkillers and medicines to stop you feeling sick. Read the patient information leaflet that comes with your medicine and ask your doctor or a pharmacist if you need advice.
Sometimes, medical treatment doesn’t work and you may need surgery. Your doctor will ask you to do a pregnancy test three weeks after you take the medicine. If it’s positive or if your bleeding is hard to deal with, go back to your doctor for more advice.
Surgery
Surgery can remove any tissue from your womb. There are two main procedures.
- Surgery 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.
Your doctor will explain exactly what will happen and answer any questions you have, before you decide whether or not to go ahead.
If you have a rhesus negative blood group, your doctor will offer you an anti-D rhesus injection after your surgery. This will stop your body from forming antibodies, which could be harmful to your baby if you get pregnant again.
Having a late miscarriage
A late miscarriage happens between 14 and 23 weeks of pregnancy. If you lose a pregnancy after this time, it’s known as a stillbirth. Going through a late miscarriage can be devastating. Your hospital team will do all they can to support you.
You’ll usually need to go through the process of labour and deliver your baby if you’ve had a late miscarriage. This can happen naturally or you may need to take medicines to start (induce) labour. You can see and 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.
Afterwards, you may have some bleeding and tummy cramps like period pain, which may last for several weeks. You’ll probably feel very tired and emotional.
After a miscarriage
Physical effects
It may take several weeks for the physical effects of a miscarriage to clear and you may feel tired and run down. Your periods should return to normal within about six weeks.
If you’ve had a late miscarriage, your breasts may be painful and produce milk. 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
Everyone reacts differently to having a miscarriage 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 loss. It’s also normal to feel shocked, angry and numb.
Some people feel guilty when they have a miscarriage. But it's very unlikely that your miscarriage happened because of something you did or didn’t do. You can’t prevent the things that most often cause miscarriages.
It can be a difficult time for your partner too and it’s important that you both get the support you need. You should have a follow-up appointment with your GP or other health professional. They can talk things through with you and may refer you for counselling or tell 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. Most miscarriages are a one-off event and there’s a good chance you’ll have a successful pregnancy in the future.
It’s best to wait until your bleeding stops before you have sex again as it will help to prevent an infection. You may also prefer to wait until you’ve had a period before you try 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 get pregnant 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 get the results.
Otherwise, if you feel physically and emotionally ready, there’s no medical reason why you need to wait to try again. If you don’t want to get pregnant, you’ll need to use contraception immediately after your miscarriage.
Your baby
If you had a late miscarriage, your hospital may offer 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. But a post-mortem may provide information that will help medical staff to care for you if you get pregnant in the future.
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 the choice to make your own private arrangements if you prefer.
Prevention of miscarriage
You can’t prevent most miscarriages. But there are some things you can do that may reduce your risk.
- 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 and drugs are harmful to you and your baby.
- Eat a healthy balanced diet and don’t eat any foods known to increase the risk of miscarriage. These include unpasteurised dairy products, soft and blue cheeses, and raw or undercooked meat.
- Maintain a healthy weight before and during your pregnancy. Ask your midwife if you’re unsure.
- Make every effort not to get infections that might harm your baby – for example, malaria. It’s best not to visit any countries where there’s a risk of malaria while you're pregnant. If you have to travel, speak to your GP or travel clinic for advice before you go.
If your doctor finds a cause, there may be a treatment to help prevent another miscarriage. For example, antiphospholipid syndrome (APS) can be treated with medicines.
If you have a weakened cervix, your doctor may offer you a procedure called a cervical stitch. 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, and this may cause a miscarriage. In a cervical stitch procedure, your doctor will put a strong stitch or tape around your cervix to give it more support. This will help to keep it closed during your pregnancy. Your doctor will usually remove the stitch at about 37 weeks, ready for you to give birth.
The first sign of a miscarriage is bleeding from your vagina. You may have some light spotting, or it can be very heavy bleeding that goes on for several days. You might have tummy pain too.
For more information, see our section – Symptoms of miscarriage.
You probably won’t need to go to hospital after a miscarriage as it will usually happen naturally, in its own time. But if you’re still bleeding after two weeks, your doctor may arrange for you to have another scan, and possibly, treatment. You might need to go to hospital for some surgery.
For more information, see our section – Management of miscarriage.
A miscarriage can be devastating for both you and your partner and it’s important that you get the support you need. This starts with a follow-up appointment with your GP or other health professional. They can talk things through with you and may refer you for counselling or tell you where you can get further support.
For more information, see our section – After a miscarriage.
Depression
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