Miscarriage: Signs, Symptoms, and Causes

What is a miscarriage? Most people are aware that this phenomenon involves the unintended loss of a fetus, but questions about the signs, symptoms, and causes of miscarriage remain. The following overview provides basic information about miscarriage symptoms and related topics. If you believe that you are experiencing pregnancy complications, be sure to speak with your health care provider immediately.

Miscarriage Causes

According to the American College of Obstetricians and Gynecologists, miscarriage is the most common form of pregnancy loss. Most of the time, miscarriage happens when the fetus has chromosomal abnormalities. While these flaws are usually caused by damaged egg and/or sperm cells and not normally related to the mother, there are many other instances when the mother suffers from health complications that can potentially lead to miscarriage.

Some of the most common ones include:

• Thyroid disease, diabetes, or another medical condition

• Physical problems such as uterine abnormalities

• Infection or immune system response

• Hormonal problems

• Lifestyle factors such as smoking, exposure to toxins, malnutrition, drug use, or excessive caffeine intake

• Cervical insufficiency

There are many cases in which the cause of miscarriage is unknown. Often, miscarriages happen before pregnancy is ever diagnosed; in fact, according to the March of Dimes, as many as fifty percent of all pregnancies are miscarried. The majority of miscarriages happen before the mother ever misses her period or realizes that she is pregnant. Of all recognized pregnancies, approximately 15 to 25 percent end with a miscarriage. Of these, more than 80% happen during the first trimester.

Preventing Miscarriage

Is it ever possible to prevent a miscarriage? While no one can prevent miscarriages caused by chromosomal abnormalities, it is possible to take steps to protect your health and prevent problems related to lifestyle factors. If you have had a miscarriage in the past, you may wish to make an extra effort and team up with your doctor as you plan for future pregnancies.

Some lifestyle-related tips to try before pregnancy include:

• Take at least 400 mg of folic acid daily, preferably beginning in the months before conception

• Eat a healthy, balanced diet

• Exercise regularly

• Keep your weight within a normal range for your height

• Do not smoke; be sure to avoid secondhand smoke

• Limit caffeine consumption to one or two cups of coffee or other caffeinated beverages per day

• Avoid alcohol

• Avoid illicit drugs

• Manage your stress

• Ensure that your recommended immunizations are up to date

During pregnancy, you can reduce your miscarriage risk by:

• Protecting your abdomen from physical trauma

• Not smoking and avoiding second hand smoke

• Limiting caffeine to one cup of a caffeinated beverage per day, or eliminating it altogether

• Not drinking alcohol

• Checking with your doctor before taking medications, including over-the-counter varieties

• Avoiding people who are sick

• Avoiding hazards such as x-rays and radiation

• Avoiding activities that could cause injury, i.e. contact sports

Signs of Miscarriage

What does a miscarriage look like? It’s important to know what miscarriage symptoms to watch for, and to contact your doctor right away if you suspect that you could be suffering from complications.

Some of the most common signs of miscarriage include:

• Bleeding, particularly when it begins as a small amount and increases to a heavier flow

• Severe cramping and/or abdominal pain

• Mild to severe lower back pain that may feel stronger than menstrual cramping

• Whitish-pink mucus discharge

• Fever

• Weight loss

• Weakness

• Painful contractions occurring an average of 5 to 20 minutes apart

• Brown to bright-red bleeding, either with or without cramping

• A sudden decrease in pregnancy symptoms

• Vaginal discharge of tissue containing material that looks like blood clots

Miscarriage Types

There are several different miscarriage types to be aware of:

• Complete Miscarriage – The uterus is completely emptied, with pain, cramping, and bleeding subsiding shortly afterward. If bleeding and cramps persist, then the miscarriage might be termed inevitable or incomplete. Your doctor may perform an ultrasound or you may need to have a surgical D&C.

• Missed Miscarriage – When pregnancy symptoms cease and ultrasound fails to show any fetal heart tones, but the embryo has not been expelled, a missed miscarriage may have occurred. This general term refers to a miscarriage in which fetal death occurs but the woman does not realize what has happened, typically due to a lack of common symptoms.

• Blighted Ovum – Also known as an embryonic pregnancy, a blighted ovum is a pregnancy that fails to result in fetal growth. The egg is fertilized and is implanted into the uterine wall. A gestational sac is present, sometimes with and sometimes without a yolk sac; however, fetal development does not begin. This type of miscarriage can be particularly confusing, because hCG levels will increase and the placenta will continue to grow as if a fetus were present. Diagnosis usually happens with ultrasound, when testing shows an empty gestational sac or even an empty womb. Minor spotting and/or bleeding might be present, along with minor cramping.

• Ectopic (Tubal) Pregnancy – This type of miscarriage threatens the mother’s health and/or life; it occurs when the fertilized egg is implanted anywhere other than the uterine wall. The implanted egg cannot develop into a full-term pregnancy, and severe complications will develop without immediate treatment. An ectopic pregnancy often comes with sharp, stabbing pains; vaginal bleeding; fainting, weakness, or dizziness; and/or gastrointestinal symptoms. Contact your doctor right away if you experience sharp pain that lasts longer than a few minutes, as well as for any type of bleeding.

• Molar Pregnancy – When this type of miscarriage occurs, it often seems as if a normal pregnancy is present, diagnosed via a missed period, confirmed by positive pregnancy testing, and even backed up by serious nausea or other common pregnancy symptoms. Despite these signs, a genetic error has occurred during the fertilization process, causing a placenta and abnormal tissue to grow instead of an embryo. Molar pregnancies are extremely rare, occurring in just one of every 1,000 pregnancies.

• Partial Molar Pregnancy – In a partial molar pregnancy, the cell tissue will consist not only of abnormal cells, but will also include an embryo with severe birth defects. The abnormal cell growth outpaces the embryonic growth, resulting in miscarriage.

Chances of Miscarriage

Because every pregnancy is different, the chances of miscarriage vary from one individual to the next. Some women are at a higher risk of miscarriage than others. In general, the risk is elevated for those who:

• Are over the age of 35

• Suffer from thyroid problems, diabetes, or other diseases

• Have a medical history that includes three or more previous miscarriages (recurrent miscarriages)

Age plays an important role in miscarriage risk. For all women of childbearing age, the chances of miscarriage are between ten and twenty-five percent. Those who are between the ages of 35 and 45 have a 20 to 35 percent chance of miscarriage, and the percentage jumps to 50% in women over age 45.

Caring for Yourself after a Miscarriage

It is vital to look after your emotional well-being after a miscarriage, and you may also need special care from your doctor. The level of intervention will vary depending on the type of miscarriage as well as other factors. Some examples of treatments follow.

• D&C Procedure – While some women require no intervention after a miscarriage, many do require treatment. Dilation and curettage (D&C) is performed to stop the bleeding and reduce the likelihood of infection. The cervix is opened during the procedure, which is carried out under general or local anesthesia; and surgical instruments are used to cleanse the uterine walls. Women who miscarry after 10 weeks pregnant are more likely to require D&C than those who suffer earlier miscarriages.

• Treatment After an Ectopic Pregnancy – There are a few ways in which ectopic pregnancies are treated, and treatment depends on various factors including how far the pregnancy progressed before the problem was detected.

If the fallopian tube was damaged or ruptured and is bleeding, then emergency surgery is called for. The extent of the damage determines whether the fallopian tube may be repaired or must be removed.

If emergency surgery is not necessary, methotrexate may be administered, allowing the body to absorb the tissue from the pregnancy and potentially salvaging the fallopian tube.

Every miscarriage represents a loss, and the way you process your feelings is highly personal. You and your partner are likely to feel a sense of grief, and this may be shared with other family members who knew that you were expecting. Speaking with friends, loved ones, and counselors or pastors may help, and your health care provider may be able to help you find a sense of closure too.

Many women experience physical manifestations of grief that extend beyond feelings of sadness, disbelief, and numbness. You may feel fatigued, yet you might find that you have trouble sleeping. You are likely to have difficulty concentrating, and you may lose your appetite. You may cry frequently, and your relationships might even suffer. These feelings are intensified by the hormonal shifts that accompany miscarriage.

Like other forms of grief, miscarriage comes with its own distinct grieving process.

There are three main steps to be aware of:

• Step One - Denial and Shock: You find yourself having difficulty accepting the reality that you are facing. Your doctor can help you understand what is happening physically and give you a sense of what to expect as your hormones return to pre-pregnancy levels.

• Step Two - Depression, Anger, and Guilt: Negative emotions are normal after miscarriage; You may blame yourself, your doctor, or your partner. You might be angry in general, or you may feel a sense of depression. You may find yourself questioning every move you made during your pregnancy, looking for answers that simply aren’t there. Whatever your feelings, know that miscarriage is natural, and it is not your fault. As difficult as it is, miscarriage can happen to anyone, even when they do all the right things and take the very best care of themselves. It is very important to process these feelings. If you aren’t ready to talk with others, listening to music, journaling, or even exercising may help.

• Step Three - Acceptance: The grieving process doesn’t have to come to an end with acceptance; what happens though, is that you realize that what you have experienced is a reality, and you are ready to move forward with life despite your loss.

Helpful Resources

While miscarriage is an intensely personal process for you and your partner, you don’t have to suffer alone. Simply having someone listen may ease some of your grief. Your doctor may be able to provide you with local resources; here are a few websites that may prove helpful, as well.

M.E.N.D.

Unspoken Grief