Miscarriage refers to the premature end of a pregnancy before the developing baby is able to survive outside the uterus. Miscarriage can occur during the first or second trimester, before 20 weeks. Most occur in the first 12 weeks of pregnancy. They often are unexpected and isolated events. About 15%-20% of recognized pregnancies end this way.
Fetus in First Trimester
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Miscarriages often occur for the following reasons: Chromosomal abnormalities (common cause)
Abnormalities in the uterine tract, such as
fibroidsHormonal problems, such as not having enough progesterone, a female hormone needed to support pregnancyFactors related to the immune system, such as blood-clotting problems or rejection of the fetusTrauma
In some cases, the cause of miscarriage is unknown.
Miscarriages are more common in women 35 years and older. Other factors that may increase your chance of having a miscarriage include: InfectionSmoking
, or using
Certain medicationsExposure to certain environmental toxins
Autoimmune disorders, such as
systemic lupus erythematosus
on the ovaries, uterus, or the pituitary gland during treatment of childhood cancers
A miscarriage during your first pregnancy may place you at a higher risk for complications during your next pregnancy. These complications may include:
High blood pressure during pregnancy—
pre-eclampsiaThreatened miscarriageInduced laborPreterm deliveryLow birth weightPostpartum hemorrhage
Miscarriage may cause: Vaginal bleedingPink or brown dischargeCrampingPassing the fetus, placenta, and surrounding membranes through the vaginaFever
While miscarriage usually is a one-time occurrence, up to 1 in 20 couples experience 2 miscarriages in a row, and 1 in 100 have 3 or more.
In some cases, these couples have an underlying problem. Couples who have experienced two or more miscarriages should have a complete medical evaluation to learn the cause and how they can prevent another one from occurring.
Cause of repeat miscarriages may include: Chromosome problem in one member of the coupleUterine abnormalitiesHormone problemsImmune system problemsUnknown causes
You will be asked about your symptoms, the length of your pregnancy, and when you first noticed a change in your condition. Physical and pelvic exams.
Prior to miscarriage, tests may include: Ultrasound
—to assess the health of the fetus
Blood tests—to check the exact amount of the hormone (called human chorionic gonadotropin or hCG) important to sustain an early pregnancy
After miscarriage, tests may include: Examination of the tissue that has passed through the vaginaBlood tests—to check for a chromosomal error in the man or the woman or to check hormone and antibody levelsEndometrial biopsy
—to check the uterine lining to see if it can support a pregnancy
Imaging tests may be used to evaluate the uterus and surrounding structures. These may include: X-raysUltrasoundHysteroscopy
—to examine the inside of the uterus
Immediate care usually involves observation only, especially in early or first trimester miscarriages. Medication may be indicated in the event of heavy bleeding or cramping.
A dilation and evacuation (D&E) may be needed if uterine contents are not spontaneously passed through the vagina. During a D&E, the doctor dilates the cervix, inserts a tool into the uterus, and suctions out remaining material.
To help you deal with your loss, the doctor may refer you to a counselor. You may also benefit from participating in a
Before you start to plan your next pregnancy consider the following regarding your health: Is your diet ready to support another pregnancy?Are there habits you should change prior to another pregnancy?What medications are you taking and will they affect a pregnancy?How is your health?Are there issues you should resolve before trying another pregnancy?
If a specific cause of the miscarriage was found, certain treatments may help prevent future miscarriages. Treatments may include:
Medications such as:
Antibiotics to treat related infectionsHormone (progesterone) supplementsAspirin and other medications to treat blood-clotting problems
Surgery for uterine problems such as:
Uterine fibroidsSeptate uterus (tissue in the center of the uterus)Incompetent (weakened) cervix
Miscarriage. American Pregnancy Association website. Available at:
http://americanpregnancy.org/pregnancy-complications/miscarriage. Updated August 2015. Accessed October 7, 2015.
Miscarriage. March of Dimes website. Available at:
http://www.marchofdimes.com/loss/miscarriage.aspx. Updated July 2012. Accessed October 7, 2015.
Last reviewed September 2016 by Michael Woods, MD, FAAP
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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