Losing a pregnancy can be heartbreaking. And unfortunately, miscarriages are fairly
common. On average, about 1 in 5 pregnancies will end in a miscarriage — usually
in the first trimester.
In most cases, a miscarriage cannot be prevented because it is the result of a
chromosomal abnormality or problem with the development of the fetus. Still, certain
factors — such as age, smoking, drinking, and a history of miscarriage —
put a woman at a higher risk for losing a pregnancy.
While miscarriages usually cannot be prevented, by taking care of yourself and
following your health care provider's recommendations, you can increase the chances
that you and your baby will be healthy throughout the pregnancy.
What Is a Miscarriage?
A miscarriage is the loss of a pregnancy (the loss of an embryo or fetus before
it's developed enough to survive). This often happens even before a woman is aware
that she is pregnant.
A miscarriage usually happens in the first 3 months of pregnancy, before 12 weeks'
gestation. A small fraction of pregnancy losses — happening in less than
1% of pregnancies — are called stillbirths, as they happen after 20 weeks of
Symptoms of a Miscarriage
Many women don't even know that they've had a miscarriage (since they hadn’t
known they were pregnant), thinking that it's just a particularly heavy menstrual
Some women experience cramping, spotting, heavier bleeding, abdominal pain, pelvic
pain, weakness, or back pain. Spotting is often not a sign of a miscarriage; many
women experience it early on in pregnancy. But just to be safe, if you have spotting
or any of these other symptoms anytime during your pregnancy, talk with your doctor.
Types of Miscarriage
If you think you may have had a miscarriage, your doctor may use a number of terms
to explain what has happened:
If a pregnant woman has bleeding, little or no pain, a closed cervix, and is found
to still have a fetus with a heartbeat in her uterus, she may have had a threatened
miscarriage. Most pregnancies with early bleeding but with a detectable heartbeat
turn out fine.
An inevitable miscarriage is when bleeding and cramping happen during pregnancy,
with an open cervix.
An incomplete miscarriage is when a miscarriage has happened, but the body does
not expel all the tissue from the pregnancy.
A complete miscarriage is when all of the tissue from the pregnancy is expelled
by the body.
If you have miscarried, your doctor may say you have a blighted ovum, which is
a miscarriage that has happened so early that no clearly defined fetal tissues have
A missed miscarriage is when the fetus has died or has not developed, but the
body does not discharge the fetus or tissues from the pregnancy. Sometimes women with
missed miscarriages notice that they no longer "feel pregnant."
A stillbirth, which many experts define as the death of a baby after the 20th week
of pregnancy, can happen before delivery or during labor or delivery. It is rare and
happens in less than 1% of all births. A stillbirth also is sometimes referred to
as intrauterine fetal death or antenatal death.
While there are some known risk factors for stillbirth (such as smoking, obesity,
problems with the placenta, a pregnancy lasting longer than 42 weeks, and some infections),
there is no way to predict when stillbirth will happen or who will have one, and the
cause of many stillbirths remains unknown.
The common sign of a stillbirth is decreased movement in the baby. If you notice
your baby moving less than usual, call your doctor immediately.
Your doctor can use an ultrasound to look for the heartbeat or, later in pregnancy,
give you an electronic fetal non-stress test. This involves lying on your back with
electronic monitors attached to your abdomen. The monitors record the baby's heart
rate, movements, and contractions of the uterus.
Why Do Miscarriages Happen?
The most common cause of pregnancy loss is a problem with the chromosomes that
would make it impossible for the fetus to develop normally.
Other factors that could contribute to a miscarriage include:
abnormal hormone levels in the mother, such as thyroid hormone
exposure to environmental and workplace hazards, such as radiation or toxic agents
incompetent cervix, or when the cervix begins to open (dilate) and thin (efface)
before the pregnancy has reached term
certain medications, such as the acne drug Accutane
Certain behaviors also increase the risk of a miscarriage. Smoking, for example,
puts nicotine and other chemicals into the bloodstream, causes the fetus to get less
oxygen, and increases the chance of losing a pregnancy. Alcohol and illegal drug use
also can lead to miscarriages.
After a Miscarriage
If you have miscarried, your doctor will do a pelvic exam and an ultrasound to
confirm the miscarriage. If the uterus is clear of any fetal tissue, or it is very
early in the pregnancy, then there often won't be any more treatment.
But if the uterus still contains the fetus or other tissues from the pregnancy,
this will need to be removed. The doctor may give you medicine to help pass the tissue
or may need to dilate the cervix to perform a dilation and curettage(D&C), a scraping of the uterine lining, or a dilation
and extraction(D&E), a suction of the uterus to remove
fetal or placental tissue. You may have bleeding or cramping after these procedures,
which are done with anesthesia.
If it is determined that your baby has died later in pregnancy, the doctor might
decide to induce labor and delivery. After the delivery, the doctor will have the
baby and the placenta examined to help determine the cause of death if it's still
If you've had several miscarriages, you may want to be evaluated to see if any
anatomic, genetic, or hormonal abnormalities are contributing to the miscarriages.
Can Miscarriages Be Prevented?
Although miscarriages usually can't be prevented, you can take precautions
to increase your chances of having a healthy
Exercise regularly after you've gotten your doctor's OK.
Maintain a healthy weight (women who are overweight or too thin may be more
likely to have miscarriages).
Avoid drugs and alcohol.
Avoid deli meats and unpasteurized soft cheeses such as feta and other foods that
could carry listeriosis.
Limit caffeine intake.
If you smoke, quit.
Talk to your doctor about all medications you're currently taking. Unless your
doctor tells you otherwise, many prescription and over-the-counter medicines
should be avoided during pregnancy.
Avoid activities that could cause abdominal trauma.
Get immunized against communicable diseases and know your family medical and genetic
Go to all of your scheduled prenatal appointments and discuss any concerns with
Call your doctor right away if you have fever, feel ill, notice decreased fetal
movements, or are having bleeding, spotting, or cramping.
If you've had a miscarriage, it's important to take time to grieve. The loss of
a baby during pregnancy is like the loss of any loved one. Give yourself time to heal
emotionally and physically. Some health care providers recommend that women wait one
menstrual cycle or more before trying to get pregnant again to give their bodies and
psyches time to heal.
Some other things that can help you get through this difficult time:
Attend a support group. Ask your doctor about local support groups
for women who are trying again after a loss.
Find success stories. Other women who have had a successful pregnancy
after having a miscarriage can be a great source of encouragement to you. Your doctor
might be able to give you the name of someone to talk with.
During future pregnancies, it can help to:
Request frequent prenatal
visits. Even if you aren't medically high-risk, when you do get pregnant,
ask your doctor if you could schedule prenatal appointments more often for your own
peace of mind.
Be proactive. The more you know about the medical aspects of
your pregnancy, the better you'll be able to discuss treatment options and outcomes
with your doctor.
Monitor the baby's movements. If you're far enough along —
usually between 18 and 22 weeks — to feel kicks and jabs, keep a log of the
baby's activities each morning and night and report any abnormalities or lack of movement
to your doctor. If your baby isn't moving, eat or drink something sugary and lie down
on your side. You should feel at least 10 movements in a 2-hour period. If you don't,
call your doctor immediately.
Try not to compare. No two pregnancies are exactly alike, so
try not to dwell on any similarities between this pregnancy and the one that ended
in a loss.
Stay positive. Remember that before long, the lost pregnancy
will be a distant memory and that there is a good end in sight.