What happens – Miscarriage

Contact your hospital immediately if the bleeding becomes particularly heavy, you develop a high temperature (fever) or you experience severe pain.

Miscarriage

A miscarriage is the loss of a pregnancy before 20 weeks’ gestation. Most miscarriages happen in the first trimester of pregnancy. Chromosomal problems cause most miscarriages.

Overview

What is a miscarriage?

A miscarriage (also called a spontaneous abortion) is the unexpected ending of a pregnancy in the first 20 weeks of gestation. Just because it’s called a “miscarriage” doesn’t mean you did something wrong in carrying the pregnancy. Most miscarriages are beyond your control and occur because the fetus stops growing.

Types of miscarriage

Your pregnancy care provider may diagnose you with the following types of miscarriage:

• Missed miscarriage: You’ve lost the pregnancy but are unaware it’s happened. There are no symptoms of miscarriage, but an ultrasound confirms the fetus has no heartbeat.
• Complete miscarriage: You’ve lost the pregnancy and your uterus is empty. You’ve experienced bleeding and passed fetal tissue. Your provider can confirm a complete miscarriage with an ultrasound.
• Recurrent miscarriage: Three consecutive miscarriages. It affects about 1% of couples.
• Threatened miscarriage: Your cervix stays closed, but you’re bleeding and experiencing pelvic cramping. The pregnancy typically continues with no further issues. Your pregnancy care provider may monitor you more closely for the rest of your pregnancy.
• Inevitable miscarriage: You’re bleeding, cramping and your cervix has started to open (dilate). You may leak amniotic fluid. A complete miscarriage is likely.

How do I know if I’m having a miscarriage?

You may not be aware you’re having a miscarriage. In people who have symptoms of a miscarriage, the most common signs are:

• Bleeding that progresses from light to heavy. You may also pass grayish tissue or blood clots.
• Cramps and abdominal pain (usually worse than menstrual cramps).
• Low back ache that may range from mild to severe.
• A decrease in pregnancy symptoms.

Contact your pregnancy care provider right away if you’re experiencing any of these symptoms. They will tell you to come into the office or go to the emergency room.

Symptoms and Causes

What causes miscarriage?

Chromosomal abnormalities cause about 50% of all miscarriages in the first trimester (up to 13 weeks) of pregnancy. Chromosomes are tiny structures inside the cells of your body that carry your genes. Genes determine all of a person’s physical attributes, such as assigned sex, hair and eye color and blood type.

During fertilization, when the egg and sperm join, two sets of chromosomes come together. If an egg or sperm has more or fewer chromosomes than normal, the fetus will have an abnormal number. As a fertilized egg grows into a fetus, its cells divide and multiply several times. Abnormalities during this process also leads to miscarriage.

Most chromosomal problems occur by chance. It’s not completely known why this happens.

Several factors may cause miscarriage:

• Infection.
• Exposure to TORCH diseases.
• Hormonal imbalances.
• Improper implantation of fertilized egg in your uterine lining.
• How old you are.
• Uterine abnormalities.
• Incompetent cervix (your cervix begins to open too early in pregnancy).
• Lifestyle factors such as smoking, drinking alcohol or using recreational drugs.
• Disorders of the immune system like lupus.
• Severe kidney disease.
• Congenital heart disease.
• Diabetes that isn’t managed.
• Thyroid disease.
• Radiation.
• Certain medicines, such as the acne drug isotretinoin (Accutane®).
• Severe malnutrition.

There is no scientific proof that stress, exercise, sexual activity or prolonged use of birth control pills cause miscarriage. Whatever your situation is, it’s important to not blame yourself for having a miscarriage. Most miscarriages have nothing to do with something you did or didn’t do.

How painful is a miscarriage?

Miscarriages are different for every person. Some people have painful cramping, while other people have cramps similar to their menstrual period. The type of miscarriage you have may also affect your pain level. For example, if you have a complete miscarriage at home, you may have more pain than a person who has a missed miscarriage and has a surgical procedure to remove the pregnancy.

What happens first during a miscarriage?

It’s hard to say what happens first during a miscarriage because everyone’s symptoms are different. Sometimes there are no signs of miscarriage, and you find out at a prenatal ultrasound that you’ve lost the pregnancy. Most people will experience some degree of cramping and bleeding, but what happens first varies.

How long does a miscarriage take?

It depends. Some people have painful cramping and heavy bleeding longer than others. Your pregnancy care provider can tell you what to expect and give you advice on how to manage pain and cramps during your miscarriage.

What are the risk factors for a miscarriage?

A risk factor is a trait or behavior that increases a person’s chance of developing a disease or condition. Risk factors for miscarriage include:

• Your age: Studies show that the risk of miscarriage is 12% to 15% for people in their 20s and rises to about 25% for people by age 40. Most age-related miscarriages happen because of a chromosomal abnormality (the fetus has missing or extra chromosomes).
• Previous miscarriage: You have a 25% chance of having another miscarriage (only slightly higher than someone who hasn’t had a miscarriage) if you’ve already had one.
• Health conditions: Certain health conditions like unmanaged diabetes, infections or issues with your uterus or cervix increase your chance of miscarriage.

Talk to your pregnancy care provider about the risk factors for miscarriage. They can discuss your risk after they’ve reviewed your medical history.

How many people have miscarriages?

Between 10% and 20% of all known pregnancies end in miscarriage. Most miscarriages (80%) happen within the first three months of pregnancy (up to 13 weeks of pregnancy). Less than 5% of miscarriages occur after 20 weeks’ gestation.The rate of miscarriage may be higher if you consider miscarriages that happen shortly after implantation. A person may not realize they’re pregnant because bleeding happens around the time of their menstrual period. This is called a chemical pregnancy.

What is my risk of miscarriage by week?

Your risk of pregnancy loss declines each week you’re pregnant. Around 15% of pregnancies end in miscarriage. Miscarriage risk in the second trimester (13 to 19 weeks) is between 1% and 5%. Many factors affect your risk of miscarriage such as your age and health. However, everyone’s risk of miscarriage declines each week of pregnancy if the pregnant person has no other health conditions.

Diagnosis and Tests

How is a miscarriage diagnosed?

Your pregnancy care provider will perform an ultrasound test to confirm a miscarriage. These tests check for fetal heartbeat or the presence of a yolk sac (one of the first fetal structures your provider can see on ultrasound).

You may also have a blood test to measure human chorionic gonadotropin (hCG), a hormone produced by the placenta. A low hCG level can confirm a miscarriage.

Finally, your provider may perform a pelvic exam to check if your cervix has opened.

Management and Treatment

What are the treatments for a miscarriage?

If you experience the loss of a pregnancy, the fetus must be removed from your uterus. If any parts of the pregnancy are left inside your body, you could experience infection, bleeding or other complications.

If the miscarriage is complete and your uterus expels all the fetal tissue, then no further treatment is usually needed. Your pregnancy care provider will conduct an ultrasound to make sure there’s nothing left in your uterus.

If your body doesn’t remove all the tissue on its own or you haven’t started to bleed, your pregnancy care provider will recommend removing the tissue with medication or surgery.

Nonsurgical treatment

Your pregnancy care provider may recommend waiting to see if you pass the pregnancy on your own. This may be the case if you have a missed miscarriage. Waiting for a miscarriage to start could take several days. If waiting to pass the tissue isn’t safe or you wish to remove the tissue as soon as possible, they may recommend taking a medication that helps your uterus pass the pregnancy. These options are typically only available if you’ve miscarried before 10 weeks of pregnancy.

If a miscarriage wasn’t confirmed, but you had symptoms of a miscarriage, your provider may prescribe bed rest for several days. You might be admitted to the hospital overnight for observation. When the bleeding stops, you may be able to continue with your normal activities. If your cervix is dilated, they may diagnose you with an incompetent cervix, and they may perform a procedure to close your cervix (cervical cerclage).

Surgical treatment

Your provider may perform a dilation and curettage (D&C) or dilation and evacuation (D&E) if your uterus hasn’t passed the pregnancy or if you’re bleeding heavily. Surgery may also be the only option if your pregnancy is beyond 10 weeks’ gestation. During these procedures, your cervix is dilated, and any remaining pregnancy-related tissue is gently scraped or suctioned out of your uterus. Your provider performs these surgeries in a hospital, and you’ll be under anesthesia.

What are some of the symptoms after a miscarriage?

Spotting and mild discomfort are common symptoms after a miscarriage.

Contact your healthcare provider immediately if you have any of these symptoms as it could be signs of an infection:

• Heavy bleeding or worsening bleeding.
• Fever.
• Chills.
• Intense pain.

Don’t put anything inside your vagina for at least two weeks after a miscarriage. This includes tampons, sexual intercourse and fingers or sex toys. Your provider will schedule a follow-up appointment with you to discuss your recovery and any complications.

What tests should I have after repeat miscarriages?

Blood tests or genetic tests might be necessary if you’ve more than three miscarriages in a row (called repeated miscarriage). These include:

• Genetic tests: You and your partner can have blood tests, like karyotyping, to check for chromosome abnormalities. If tissue from the miscarriage is available, your provider may be able to test it for chromosome irregularities.
• Blood tests: You may have a blood test to check for autoimmune or hormone conditions that could be causing miscarriages.

Your provider may also look at your uterus using one of the following procedures:

• Hysterosalpingogram (an X-ray dye test of your uterus and fallopian tubes).
• Hysteroscopy (a test during which your provider views the inside of your uterus with a thin, telescope-like device).
• Laparoscopy (a procedure during which your provider views the pelvic organs with a lighted device).

What happens – Miscarriage

However, if there’s still some pregnancy tissue in your womb, your options are:

• expectant management – wait for the tissue to pass out of your womb naturally
• medical management – take medicine that causes the tissue to pass out of your womb
• surgical management – have the tissue surgically removed

The risk of complications is very small for all these options. It’s important to discuss them all with the doctor in charge of your care.

Expectant management

If you have a miscarriage in your first trimester, you may choose to wait 7 to 14 days after a miscarriage for the tissue to pass out naturally. This is called expectant management.

If the pain and bleeding have lessened or stopped completely during this time, this usually means the miscarriage has finished. You should be advised to take a home pregnancy test after 3 weeks.

If the test shows you’re still pregnant, contact a healthcare professional as you may need to have further tests.

If the pain and bleeding have not started within 7 to 14 days or are continuing or getting worse, this could mean the miscarriage has not begun or has not finished. In this case, you should be offered another scan.

After this scan, you may decide to either continue waiting for the miscarriage to occur naturally, or have drug treatment or surgery. If you choose to continue to wait, your healthcare professional should check your condition again up to 14 days later.

Contact your hospital immediately if the bleeding becomes particularly heavy, you develop a high temperature (fever) or you experience severe pain.

Medicine

You may choose to have medicine to remove the tissue if you do not want to wait, or if it does not pass out naturally within 2 weeks. This involves taking tablets that cause the cervix to open, allowing the tissue to pass out.

In most cases, you’ll be offered tablets called pessaries that are inserted directly into your vagina, where they dissolve.

The tablets usually begin to work within a few hours. You’ll experience symptoms similar to a heavy period, such as cramping and heavy vaginal bleeding. You may also experience vaginal bleeding for up to 3 weeks.

In most units, you’ll be sent home for the miscarriage to complete. This is safe, but ring your hospital if the bleeding becomes very heavy.

You should be advised to take a home pregnancy test 3 weeks after taking this medicine. If the pregnancy test shows you’re still pregnant, contact a healthcare professional as you may need to have further tests.

You should also contact a healthcare professional if your pregnancy test is negative and you’re still having bleeding or other symptoms, such as pelvic pain or a high temperature (fever), after 3 weeks.

You should be advised to contact your healthcare professional to discuss your options if bleeding has not started within 48 hours of taking the medicine.

Surgery

In some cases, surgery is used to remove any remaining pregnancy tissue. You may be advised to have immediate surgery if:

• you experience continuous heavy bleeding
• there’s evidence the pregnancy tissue has become infected
• medicine or waiting for the tissue to pass out naturally has been unsuccessful

Surgery involves removing any remaining tissue in your womb with a suction device. You should be offered a choice of general anaesthetic or local anaesthetic if both are suitable.

After a miscarriage

A miscarriage can be very upsetting, and you and your partner may need counselling or support. You may also have questions about trying for another baby and what happens to the miscarried foetus.

Page last reviewed: 09 March 2022
Next review due: 09 March 2025

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