Miscarriages

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 sometimes happens even before a woman knows she is pregnant. Unfortunately, miscarriages are fairly common.

A miscarriage usually happens in the first 3 months of pregnancy, before 12 weeks' gestation. A very small number of pregnancy losses are called stillbirths, and happen after 20 weeks’ gestation.

What Happens During a Miscarriage?

Often, a woman can have an extra heavy menstrual flow and not realize it’s a miscarriage because she hadn’t known she was pregnant.

Some women who miscarry have cramping, spotting, heavier bleeding, abdominal pain, pelvic pain, weakness, or back pain. Spotting does not always mean a miscarriage. Many pregnant women have spotting early in the pregnancy and go on to have a healthy baby. But just to be safe, if you have spotting or any of these other symptoms anytime during your pregnancy, talk with your doctor.

What Is Stillbirth?

Many experts define a stillbirth as the death of a baby after the 20th week of pregnancy. It can happen before delivery or during labor or delivery. A stillbirth also is sometimes referred to as intrauterine fetal death or antenatal death.

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. But the cause of many stillbirths isn’t found.

The most common sign of a stillbirth is decreased movement in the baby. If you notice your baby moving less than usual, call your doctor right away. Your doctor can use an ultrasound to look for the heartbeat or, later in pregnancy, give you a fetal non-stress test. This involves lying on your back with electronic monitors on your abdomen. The monitors record the baby's heart rate and 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 things that could play a role include:

• low or high hormone levels in the mother, such as thyroid hormone
• uncontrolled diabetes in the mother
• exposure to environmental and workplace hazards, such as radiation or toxic agents
• some infections
• uterine abnormalities
• incompetent cervix, which is when the cervix begins to open (dilate) and thin (efface) before the pregnancy has reached term
• the mother taking some medicines, such as the acne drug Accutane

A miscarriage also can be more likely in pregnant women who:

• smoke, because nicotine and other chemicals in the mother’s bloodstream cause the fetus to get less oxygen
• drink alcohol and or use illegal drugs

What Happens After a Miscarriage?

If a woman miscarries, her 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, many won’t need further treatment.

Sometimes, the uterus still contains the fetus or other tissues from the pregnancy. A doctor will need to remove this. The doctor may give medicine to help pass the tissue or may dilate the cervix to do:

• a dilation and curettage (D&C), a scraping of the uterine lining
• a dilation and extraction (D&E), a suction of the uterus to remove fetal or placental tissue

A woman may have bleeding or cramping after these procedures.

If a baby dies later in a woman’s pregnancy, the doctor might induce labor and delivery. After the delivery, the doctor will have the baby and the placenta examined to help find the cause of death if it's still unknown.

Women who have had several miscarriages may want to get checked to see if any anatomic, genetic, or hormonal problems are making miscarriages more likely.

Can Miscarriages Be Prevented?

In most cases, a miscarriage cannot be prevented because it’s caused by a chromosomal abnormality or problem with the development of the fetus. Still, some things — such as smoking and drinking — put a woman at a higher risk for losing a pregnancy.

Good prenatal care can help moms and their babies stay healthy throughout the pregnancy. If you’re pregnant:

• Eat a healthy diet with plenty of folic acid and calcium.
• Take prenatal vitamins daily.
• Exercise regularly after you've gotten your doctor's OK.
• Keep a healthy weight. Pregnant 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 medicines you take. Unless your doctor tells you otherwise, many prescription and over-the-counter medicines should be avoided during pregnancy.
• Avoid activities that could cause you to get hit in the belly.
• Make sure you’re up to date on all recommended vaccines.
• Know your family medical and genetic history.
• Go to all of your scheduled prenatal visits and discuss any concerns with your doctor.
• Call your doctor right away if you have fever; feel ill; notice the baby moving less; or have bleeding, spotting, or cramping.

Trying Again After a Miscarriage

If you've had a miscarriage, 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.

Some other things that can help you get through this difficult time:

• Find 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. Your doctor might know someone to talk with.

During future pregnancies, it can help to:

• 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 to feel kicks and jabs — usually between 18 and 22 weeks — keep a log of the baby's activities each morning and night and report any changes 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 right away.
• 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. Envision a good end to help you stay positive.