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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.
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.
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.
Common signs of a miscarriage include:
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.
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:
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.
Learning about miscarriage:
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Symptoms of a miscarriage include:
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.
Things that may increase your risk of miscarriage include:
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.
A miscarriage is diagnosed with:
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
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.
If you have vaginal bleeding but tests suggest that your pregnancy is still progressing, your doctor may recommend:
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:
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.
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.
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:
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.
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:
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.
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.
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.
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.
This website has information about sudden infant death, grieving the loss of an infant, and general infant health.
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.
CitationsNational 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 ConsultedAmerican 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.
Last Revised: February 1, 2013
Author: Healthwise Staff
Medical Review: Sarah Marshall, MD - Family Medicine & Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology
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