Miscarriage

Topic Overview

Is this topic for you?

This topic is about the loss of a baby before 20 weeks of pregnancy. For information about the loss of a baby after 20 weeks of pregnancy but before the baby is born, see the topic Stillbirth.

What is a miscarriage?

A miscarriage is the loss of a pregnancy during the first 20 weeks. It is usually your body's way of ending a pregnancy that has had a bad start. The loss of a pregnancy can be very hard to accept. You may wonder why it happened or blame yourself. But a miscarriage is no one's fault, and you can't prevent it.

Miscarriages are very common. For women who already know they are pregnant, about 1 out of 6 have a miscarriage.¹ It is also common for a woman to have a miscarriage before she even knows that she is pregnant.

What causes a miscarriage?

Most miscarriages happen because the fertilized egg in the uterus does not develop normally. A miscarriage is not caused by stress, exercise, or sex. In many cases, doctors don't know what caused the miscarriage.

The risk of miscarriage is lower after the first 12 weeks of the pregnancy.

What are the common symptoms?

Common signs of a miscarriage include:

Bleeding from the vagina. The bleeding may be light or heavy, constant or off and on. It can sometimes be hard to know whether light bleeding is a sign of miscarriage. But if you have bleeding with pain, the chance of a miscarriage is higher.
Pain in the belly, lower back, or pelvis.
Tissue that passes from the vagina.

How is a miscarriage diagnosed?

Call your doctor if you think you are having a miscarriage. If your symptoms and a pelvic exam do not show whether you are having a miscarriage, your doctor can do tests to see if you are still pregnant.

How is it treated?

No treatment can stop a miscarriage. As long as you do not have heavy blood loss, a fever, weakness, or other signs of infection, you can let a miscarriage follow its own course. This can take several days.

If you have Rh-negative blood, you will need a shot of Rhogam. This prevents problems in future pregnancies. If you have not had your blood type checked, you will need a blood test to find out if you are Rh-negative.

Many miscarriages complete on their own. But sometimes treatment is needed. If you are having a miscarriage, work with your doctor to watch for and prevent problems. If the uterus does not clear quickly enough, you could lose too much blood or develop an infection. In this case, medicine or a procedure called a dilation and curettage (D&C) can more quickly clear tissue from the uterus.

A miscarriage doesn't happen all at once. It usually takes place over several days, and symptoms vary. Here are some tips for dealing with a miscarriage:

Use pads instead of tampons. It is normal to have mild or moderate vaginal bleeding for 1 to 2 weeks. It may be similar to or slightly heavier than a normal period. The bleeding should get lighter after a week. You may use tampons during your next period, which should start in 3 to 6 weeks.
Take acetaminophen (Tylenol) for cramps. Read and follow all instructions on the label. You may have cramps for several days after the miscarriage.
Eat a balanced diet that is high in iron and vitamin C. You may be low in iron because of blood loss. Foods rich in iron include red meat, shellfish, eggs, beans, and leafy green vegetables. Foods high in vitamin C include citrus fruits, tomatoes, and broccoli. Talk to your doctor about whether you need to take iron pills or a multivitamin.
Talk with family, friends, or a counselor if you are having trouble dealing with the loss of your pregnancy. If you feel very sad or depressed for longer than a couple of weeks, talk to a counselor or your doctor.
Talk with your doctor about any future pregnancy plans. Most doctors suggest that you wait until you have had at least one normal period before you try to get pregnant again. If you don't want to get pregnant, ask your doctor about birth control options.

After a miscarriage, are you at risk for miscarrying again?

Miscarriage is usually a chance event, not a sign of an ongoing problem. If you have had one miscarriage, your chances for future successful pregnancies are good. It is unusual to have three or more miscarriages in a row. But if you do, your doctor may do tests to see if a health problem may be causing the miscarriages.

Frequently Asked Questions

Learning about miscarriage:	What is a miscarriage? What are common symptoms of a miscarriage? What causes a miscarriage? What might increase my risk of miscarriage?
Being diagnosed:	How is a miscarriage diagnosed?
Getting treatment:	When should I call my doctor about cramping or bleeding? How is a miscarriage treated? Should I have medical, surgical, or no treatment to complete a miscarriage? How do I take care of myself at home when I am having a miscarriage? How can I cope with a miscarriage?
Ongoing concerns:	How soon can I try to conceive after a miscarriage?

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	Miscarriage: Should I Have Treatment to Complete a Miscarriage?

Symptoms

Symptoms of a miscarriage include:

Vaginal bleeding that may be light or heavy, constant or irregular. Although bleeding is often the first sign of a miscarriage, first-trimester bleeding may also occur with a normal pregnancy. But bleeding with pain is a sign that miscarriage is more likely.
Pain. You may have pelvic cramps, belly pain, or a persistent, dull ache in your lower back. Pain may start a few hours to several days after bleeding has begun.
Blood clots or grayish (fetal) tissue passing from the vagina.

It is not always easy to tell whether a miscarriage is taking place. A miscarriage often does not occur as a single event but as a chain of events over several days. One woman's physical experience of a miscarriage can be very different from another woman's experience.

Risk factors for miscarriage

Things that may increase your risk of miscarriage include:

Your age, especially at age 35 and older.
A history of recurrent miscarriage (three or more).
Polycystic ovary syndrome , which can cause ovulation problems, obesity, increased male hormone levels, and an increased risk of diabetes.
Certain bacterial or viral infections during pregnancy.
A blood-clotting disorder such as antiphospholipid antibody syndrome.
Problems with the structure of the uterus (such as a T-shaped uterus).
Exposure to dangerous chemicals or certain medicines.
The father's age, especially beyond age 35.²
Alcohol use, cigarette smoking, or cocaine use during pregnancy.
Heavy caffeine use during pregnancy.

It is normal to wonder whether you did something to cause your miscarriage. It may help to know that most miscarriages happen because the fertilized egg in the uterus does not develop normally, not because of something you did. A miscarriage is not caused by stress, exercise, or sex.

Exams and Tests

A miscarriage is diagnosed with:

A pelvic exam, which allows the doctor to see whether the cervix is opening (dilating) or whether there is tissue or blood in the cervical opening or the vagina.
A blood test, which checks the level of the pregnancy hormone called human chorionic gonadotropin (hCG). Your doctor may take several measurements of hCG levels over a period of days to learn whether your pregnancy is still progressing.
An ultrasound, which helps your doctor find out whether the amniotic sac is intact, detect a fetal heartbeat, and estimate the age of the fetus.

If you have not had a blood test before, you may have one to see if you have Rh-negative blood.

Recurrent miscarriage. If you have three or more miscarriages, your doctor can test for possible causes, including:³

Testing your blood for antibodies to check for antiphospholipid antibody syndrome.
Using a karyotype to test your blood for parental chromosome abnormalities.
Testing hormone levels to check for polycystic ovary syndrome.
Using hysteroscopy or pelvic ultrasound to check for problems with uterine structure.

Treatment Overview

There is no treatment that can stop a miscarriage. As long as you do not have heavy blood loss, fever, weakness, or other signs of infection, you can let a miscarriage follow its own course. This can take several days.

If you have an Rh-negative blood type, you will need a shot of low-dose Rhogam. This prevents problems in future pregnancies. Your doctor can do a blood test to see if you are Rh-negative.

If a miscarriage is causing intense pain or bleeding or is taking longer than you are comfortable with, talk to your doctor about using medicine or surgery (such as a procedure called dilation and curettage, or D&C) to clear the uterus.

An obstetrician, a family medicine doctor, or a certified nurse-midwife can manage a miscarriage.

Miscarriage: Should I Have Treatment to Complete a Miscarriage?

Threatened miscarriage

If you have vaginal bleeding but tests suggest that your pregnancy is still progressing, your doctor may recommend:

Resting. You will be advised to temporarily avoid sexual intercourse (pelvic rest) and heavy activity. Your doctor may recommend bed rest. But most research shows that bed rest does not prevent miscarriage.⁴
Taking progesterone. You may be treated with the hormone progesterone to help maintain the pregnancy. This treatment, though, may serve only to delay a miscarriage and has not been proved effective for preventing a miscarriage.⁵
Avoiding NSAIDs. You will be advised to avoid aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Use only acetaminophen, such as Tylenol, for nonprescription pain relief.

Incomplete miscarriage

Sometimes all or some of the fetal tissue stays in the uterus after a pregnancy miscarries. This is called an incomplete miscarriage (incomplete or missed spontaneous abortion). If your doctor determines that you have had an incomplete miscarriage, you will have one or more treatment options:

Watchful waiting. This period of waiting, called expectant management, allows the miscarriage to end naturally while your doctor watches for and treats any complications.
Medicine. Using mifepristone or misoprostol (or both) causes the uterus to empty.
Dilation and curettage (D&C). Dilation and curettage or vacuum aspiration clears the uterus of tissue. These surgeries offer the quickest treatments for a miscarriage.

Miscarriage: Should I Have Treatment to Complete a Miscarriage?

Additional treatment concerns

If you are bleeding heavily, you will be tested for anemia and treated if needed.

In very rare cases, removal of the uterus (hysterectomy) is needed for women who have severe, uncontrollable bleeding or a severe infection that is not cured with antibiotics.

After a miscarriage

If you plan to become pregnant again, check with your doctor. Most doctors and nurse-midwives recommend waiting until you have had at least one normal menstrual period before trying to become pregnant.

Your chances of having a successful pregnancy are good, even if you've had one or two miscarriages.

If you have had three or more miscarriages (recurrent miscarriage), your doctor may suggest further testing to help find the cause.

Home Treatment

There is nothing you can do to prevent a miscarriage. It is usually the body's way of ending a pregnancy that has had a bad start, often at the earliest stage of cell division.

It is important to be alert to the symptoms of a miscarriage so that you can seek medical evaluation. If you are having symptoms of a miscarriage, avoid sexual activity (called pelvic rest) and strenuous activity until your symptoms have been evaluated by a doctor.

Call 911 or other emergency services immediately if you are pregnant and you have severe vaginal bleeding AND signs of shock. Early signs of shock include:

Lightheadedness or a feeling that you are about to pass out.
Restlessness, confusion, or signs of fear.
Shallow, rapid breathing.
Moist, cool skin or possibly profuse sweating.
Weakness.
Thirst, nausea, or vomiting.
Abnormal increase in heart rate.

Call your doctor immediately if you are pregnant and you have any vaginal bleeding or cramping pain in your abdomen, pelvis, or lower back.

Your doctor may ask you to collect any expelled clots or tissue, if possible, in a clean container. The clots may be examined to see if you have passed fetal tissue.

After a miscarriage

The most common miscarriage complications are excessive bleeding and infection.

It is normal to have mild or moderate vaginal bleeding for 1 to 2 weeks. It may be similar to or slightly heavier than a normal period. The bleeding should get lighter after a week.

Call 911 or other emergency services immediately if you have recently been treated for a miscarriage and you have severe vaginal bleeding AND signs of shock.

Call your doctor immediately if you have recently been treated for a miscarriage and you are experiencing:

Severe vaginal bleeding without signs of shock. If your doctor does not respond immediately, or if you do not have a doctor, have someone drive you to the nearest emergency room.
Symptoms of infection. These symptoms include:
- Fever of 100.4°F (38°C) or higher.
- Moderate to severe abdominal (belly) pain or cramping.
- Vaginal discharge that smells bad.

Coping with a miscarriage

It is normal to go through a grieving process after a miscarriage, regardless of the length of your pregnancy. Guilt, anxiety, and sadness are common and normal reactions after a miscarriage. It is also normal to want to know why a miscarriage has happened. In most cases a miscarriage is a natural event that could not have been prevented.

To help you and your family cope with your loss, consider meeting with a support group, reading about the experiences of other mothers, and talking to friends or a counselor or member of the clergy. For more information, see the topic Grief and Grieving.

Your local bookstore or library may have books on coping with miscarriage. Also, your doctor will be able to address your questions and concerns about the miscarriage.

The intensity and duration of the grief varies from woman to woman. But most women find that they can return to the daily demands of life in a fairly short time. The loss and the hormonal swings that result from a miscarriage can cause symptoms of depression, such as feeling sad and hopeless and losing interest in daily activities. It is important to call your doctor if you have symptoms of depression that last for more than a couple of weeks.

A healthy, full-term pregnancy is possible for most women who have had a miscarriage. This is true even after repeated miscarriages. If you want to become pregnant again, check with your doctor or nurse-midwife. Most health professionals recommend waiting until you have had at least one normal menstrual period before trying to become pregnant after a miscarriage.

Other Places To Get Help

Organizations

American Congress of Obstetricians and Gynecologists (ACOG)
409 12th Street SW
P.O. Box 70620
Washington, DC 20024-9998
Phone:	1-800-673-8444
Phone:	(202) 638-5577
Email:	resources@acog.org
Web Address:	www.acog.org

American Congress of Obstetricians and Gynecologists (ACOG) is a nonprofit organization of professionals who provide health care for women, including teens. The ACOG Resource Center publishes manuals and patient education materials. The Web publications section of the site has patient education pamphlets on many women's health topics, including reproductive health, breast-feeding, violence, and quitting smoking.

March of Dimes
1275 Mamaroneck Avenue
White Plains, NY 10605
Phone:	(914) 997-4488
Web Address:	www.marchofdimes.com

The March of Dimes tries to improve the health of babies by preventing birth defects, premature birth, and early death. March of Dimes supports research, community services, education, and advocacy to save babies' lives. The organization's website has information on premature birth, birth defects, birth defects testing, pregnancy, and prenatal care.

National Institute of Child Health and Human Development
P.O. Box 3006
Rockville, MD 20847
Phone:	1-800-370-2943
Fax:	1-866-760-5947 toll-free
TDD:	1-888-320-6942
Email:	NICHDInformationResourceCenter@mail.nih.gov
Web Address:	www.nichd.nih.gov

The National Institute of Child Health and Human Development (NICHD) is part of the U.S. National Institutes of Health. The NICHD conducts and supports research related to the health of children, adults, and families. NICHD has information on its Web site about many health topics. And you can send specific requests to information specialists.

National Sudden and Unexpected Infant/Child Death & Pregnancy Loss Resource Center
2115 Wisconsin Avenue NW
Suite 601
Washington, DC 20007-2292
Phone:	1-866-866-7437 toll-free (202) 687-7466
Fax:	(202) 784-9777
Email:	info@sidscenter.org
Web Address:	www.sidscenter.org

This website has information about sudden infant death, grieving the loss of an infant, and general infant health.

SHARE: Pregnancy and Infant Loss Support
National Share Office
402 Jackson Street
St. Charles, MO 63301
Phone:	1-800-821-6819 (636) 947-6164
Fax:	(636) 947-7486
Web Address:	www.nationalshare.org

This organization provides mutual support for bereaved parents and families who have suffered a loss due to miscarriage, stillbirth, or neonatal death. SHARE provides newsletters, pen pals, and information regarding professionals, caregivers, and pastoral care.

Related Information

References

Citations

National Institute of Child Health and Human Development (2010). Research on Miscarriage and Stillbirth. Available online: http://www.nichd.nih.gov/womenshealth/research/pregbirth/miscarriage_stillbirth.cfm.

Kleinhaus K, et al. (2006). Paternal age and spontaneous abortion. Obstetrics and Gynecology, 108(2): 369–377.

Cunningham FG, et al. (2010). Abortion. In Williams Obstetrics, 23rd ed., pp. 215–237. New York: McGraw-Hill.

Sotiriadis A, et al. (2004). Threatened miscarriage: Evaluation and management. BMJ, 329(7458): 152–155.

Haas DM, Ramsey PS (2008). Progestogen for preventing miscarriage. Cochrane Database of Systematic Reviews (2).

Other Works Consulted

American College of Obstetricians and Gynecologists (2011). Antiphospholipid syndrome. ACOG Practice Bulletin No. 118. Obstetrics and Gynecology, 117(1): 192–199.

Dempsey A, Davis A (2008). Medical management of early pregnancy failure: How to treat and what to expect. Seminars in Reproductive Medicine, 26(5): 401–410.

Duckitt K, Qureshi A (2011). Recurrent miscarriage, search date January 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.

Levens ED, et al. (2010). Ectopic pregnancy and spontaneous abortion. In EG Nabel, ed., ACP Medicine, section 16, chap. 6. Hamilton, ON: BC Decker.

National Institute of Child Health and Human Development (2010). Research on Miscarriage and Stillbirth. Available online: http://www.nichd.nih.gov/womenshealth/research/pregbirth/miscarriage_stillbirth.cfm.

Porter TF, et al. (2008). Early pregnancy loss. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 62–70. Philadelphia: Lippincott Williams and Wilkins.

Credits

By	Healthwise Staff
Primary Medical Reviewer	Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer	Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology
Last Revised	February 1, 2013