What is miscarriage?

A miscarriage is defined as a pregnancy which ends before 24 weeks when the baby would be unable to survive outside the womb. Most miscarriages happen during the first 12 weeks of pregnancy.  Late miscarriage, or second trimester loss, refers to the loss of a baby at between 14 and 24 weeks.

Causes of miscarriage

• Most early miscarriages are caused by chromosomal abnormalities that prevent the baby from developing normally.
• Infections such as rubella, listeria or Chlamydia.
• Miscarriages which occur after 20 weeks may be caused by infection or abnormality of uterus or placenta, or by a weak cervix, sometimes called an ‘incompetent cervix’. A stitch called a cerclage can be put around the cervix to rectify this.

What are the chances?

• Miscarriages are very common. Around 20% of known pregnancies end in miscarriage.
• Most women go on to have a successful pregnancy in the future. Recurrent miscarriages, defined as three or more consecutive miscarriages, are rare.

Risk factors

• Age - older women are more likely to conceive babies with chromosomal abnormalities.
• Smoking, drinking, drug use and obesity may also increase the risk of miscarriage. Find out more about how lifestyle changes can affect your fertility here.
• Too much caffeine can increase the risk of miscarriage and women are now advised to drink no more than 200mg per day. Remember that chocolate and cola also contain caffeine.

Types of miscarriage

Threatened miscarriage
Any bleeding during pregnancy is known as a ‘threatened miscarriage.’ However, some bleeding does not always mean that you will miscarry. If the cervix remains tightly closed, and a heartbeat can be detected by ultrasound, your pregnancy is likely to continue. Any bleeding during pregnancy should be reported to your doctor.

• Inevitable miscarriage: This describes bleeding during pregnancy where the cervix is open and the pregnancy will inevitably be lost.
• Incomplete miscarriage: An incomplete miscarriage means that a miscarriage has started, but some tissue is left in the womb.
• Complete miscarriage: This means the miscarriage is over. Your womb is now empty and the cervix is closed.
• Missed miscarriage: Some women are unaware they have miscarried and may only discover during a routine appointment that the baby has died.

Signs of miscarriage

• The most obvious signs of miscarriage are vaginal bleeding and pain/cramps in the lower abdomen.
• Bleeding can vary from light spotting, to as heavy, or heavier than a normal period. You may see some clots, or brown discharge or other tissues.
• Not all bleeding means miscarriage, but if you get any at all, see your doctor or midwife.
• You may notice that symptoms of pregnancy, such as morning sickness and tender breasts, disappear.

Can I do anything to stop it happening?

Sadly, there is nothing that you can do to stop a miscarriage.

Miscarriage treatment

Your doctor will help you decide the best option for you. If there are no complications you may prefer to let nature take its course.
In cases of missed or incomplete miscarriage, or if you are uncomfortable about waiting for the miscarriage to occur naturally, you may be offered:

• Surgical intervention known as ERPC (evacuation of retained products of pregnancy). This is normally done as an outpatient procedure under general anaesthetic.
• Medical management, where you are diagnosed medication which softens the cervix ad helps the womb contract to expel the remainder of the tissue.

Bleeding – how long?

Miscarriage bleeding normally lasts up to two weeks, although for some women it goes on for longer.
If you experience very heavy bleeding (more than one pad per hour), chills or fever contact your doctor as soon as possible – they could be signs of infection.

Your next period is likely to arrive four to six weeks later.

Diagnosis

Your GP will ask you about your symptoms and give you an internal examination. You may be referred to a gynaecologist or early pregnancy assessment unit for tests including:

• Ultrasound. If you are very early in your pregnancy you may be asked to return a week or so later.
• Blood tests. If you are rhesus negative you will be offered an injection to prevent rhesus disease in subsequent pregnancies.
• A pregnancy test, which may be repeated a couple of days later to check your hormone levels.

Emotional impact

The physical symptoms of miscarriage are generally not serious, however the emotional impact on both women and their partners can be significant.

Guilt, grief, depression and anger are all common reactions in the weeks or even months following a miscarriage.

Support is available from the Miscarriage Association, and there is a sympathetic support forum at Bounty.com, where you will find encouragement and advice from women who have been through the same experience.

Trying again

Women are normally advised to wait one full cycle after miscarriage before trying for another baby.