Miscarriage: Signs, Causes, Diagnosis, and Risks

Miscarriages can be traumatic, both physically and mentally. In times like these, when we feel that we're not in control, some of us find a sense of security in information and facts. If you're experiencing a miscarriage or worried that you may in the future, this helpful guide can hopefully present the symptoms, possible causes, and next steps to you in a reassuring and informative matter. 

Of course, if you are concerned about your health in relation to a miscarriage, your first step should always be talking with your doctor. A medical professional can assess your situation and discuss a plan of care with you.

Miscarriage is the term used for the loss of a pregnancy before twenty weeks gestation. It is used to describe a spontaneous abortion. Miscarriage does not happen because of something you did or didn't do. It is not something you caused. 

Most miscarriages happen within the first three months of pregnancy, a period known as the first trimester. There isn't always an identifiable cause behind a miscarriage. However, understanding the signs, symptoms, and risks may be able to help you better understand what's happening and find the necessary support.

Because a miscarriage is a pregnancy loss at any point before week twenty, the signs can vary depending on how far along in your pregnancy you are. Signs of a miscarriage may mimic your period if the loss is very early. Regardless, if you are pregnant and experience any of the following miscarriage symptoms, you should reach out to your doctor as soon as possible. 

• Vaginal bleeding 

• Frequent or heavy spotting 

• Cramping 

• Severe abdominal pain

• Loss of fluid or tissue from the vagina 

• Mild to severe back pain 

When you are pregnant, any of these symptoms can cause alarm. If you experience any of these, contact your doctor right away. Though you may still have these symptoms and not be experiencing a miscarriage, your doctor will need to evaluate you and your baby.

Miscarriage can have different causes; in some cases, the cause is unknown.  For example, research estimates that most miscarriages, around sixty percent, occur randomly as part of a genetic problem. And while studies report that an estimated ten to twenty percent of pregnant women will experience a miscarriage, the risk of miscarriage drops to about four percent after a fetal heartbeat is detected. 

These days, we're talking about miscarriage more, which can make it seem quite common. However, the threat of miscarriage needn't cause anxiety in most women. If you are concerned about conditions that could put you at higher risk or about the possibility of miscarriage, reach out to your OB. Understanding the possible causes can help you decide if you want to be in closer contact with your doctor due to the risk of miscarriage. 

Causes of first-trimester miscarriage are often the result of a genetic issue. The embryo commonly receives an incorrect number of chromosomes during fertilization. Genetic issues may also cause the fetus to develop improperly. These factors can include the following: 

• Blighted ovum when no embryo forms. 

• Intrauterine fetal demise occurs when the embryo stops growing before you experience signs of a miscarriage.

• Molar pregnancy is when the egg contains no chromosomes, and all the genetic material is only from the father. 

• A partial molar pregnancy occurs when two sperm fertilize an egg providing two sets of chromosomes in addition to the mother's chromosomes.

Issues with cell division and a damaged egg or sperm can also cause abnormalities during development that lead to miscarriage. 

Certain health conditions or lifestyle factors may contribute to miscarriage. However, in most cases, the mother is unaware of the underlying condition or the risk to her pregnancy. Things that you do, such as exercise or sexual intercourse, are often not a cause of miscarriage. Instead, factors can include: 

• Drug and alcohol abuse

• Malnutrition

• Infections

• Trauma

• Advanced maternal age

• Underlying thyroid conditions

• Hormone issues

• Unmanaged diabetes

• Obesity

• Cervix issues

• Food poisoning

• Abnormally shaped uterus

• Certain medications 

• Extremely high blood pressure 

Checking with your doctor before conception can help prevent these issues from going undiagnosed and unmanaged. When you become pregnant, bring any new symptoms to your doctor's attention and check with them before taking any new medications.

You likely won't accidentally cause a miscarriage, as most are spontaneous and a result of unpreventable genetic or developmental abnormalities. However, certain risk factors can increase the chance that you will experience a miscarriage. Such as: 

• Exposure to radiation or harmful chemicals

• Trauma to your body

• Excessive caffeine

• Drug use

• Alcohol abuse

• History of miscarriages

• Excessive smoking

• Uncontrolled health conditions such as hyperthyroidism or diabetes

• Being overweight or underweight

• Reproductive issues with the cervix or uterus 

As you age, your risk of miscarriage can also increase. Women who are thirty-five or older face a higher chance of miscarriage, which increases as they age. Having one miscarriage does not change your risk of having a future miscarriage. However, after two consecutive miscarriages, your risk increases to around twenty-eight percent. It is important to note, though, that only around one percent of women will have three or more miscarriages, with an estimated eighty-seven percent of women going on to have a full-term pregnancy after one miscarriage. 

Most miscarriages occur during the first trimester, which is weeks one to thirteen of pregnancy. Around eighty percent happen during this period. You are most at risk for a miscarriage during the earliest weeks of pregnancy. In some cases, it can happen so early that you may not even realize you are pregnant. Beginning at the sixth week of pregnancy, your risk of miscarriage drops. 

• During weeks 1-6, the risk of miscarriage is around ten to twenty percent. Though women 35-39 have a 75% higher risk of miscarriage compared to those under 35. 

• At week six, after a fetal heartbeat is confirmed, the risk lowers to ten percent. It remains around ten percent until week twelve, but some studies suggest that as gestational age increases, the risk continues to decline slightly. 

• At week thirteen, the risk becomes five percent. Generally, the risk is thought to stay at around five percent for the remainder of the pregnancy due to possible pregnancy complications. 

Another drop is seen beginning at the thirteenth week of pregnancy and continuing to lower until the twentieth week. After week twenty, your risk of miscarriage is not completely gone, as complications can still occur. Pregnancy lost past the twentieth week is known as a stillbirth.

As mentioned, miscarriages can occur so early on in pregnancy that you may not even realize you are miscarrying. Additionally, because symptoms like cramping or spotting can be similar to both, it can be tricky to differentiate a miscarriage from a period during the earliest weeks. 

If you are trying to determine if you are having a regular period or a miscarriage, consider these factors:

Timing

A period may be possible if you haven't yet confirmed pregnancy. Once pregnancy is confirmed, bleeding is unlikely to be a period. Furthermore, bleeding is not likely to be a period after eight weeks of pregnancy.

Symptoms

Miscarriage can be more painful than a period, often producing severe abdominal and back pain. Fluid or tissue passing can be more common with a miscarriage than a period. 

Length of symptoms

If the symptoms don't follow the normal pattern of your menstruation and seem like they are lasting longer or getting worse, it could be a miscarriage. 

If you are pregnant or suspect that you are pregnant and are experiencing pain or heavy bleeding, contact your doctor. 

A woman can experience various types of miscarriage. In order to determine which type, you will need to be diagnosed by a doctor. The type of miscarriage can also guide which kind of treatment you will require. 

• Missed miscarriage: the embryo does not survive, but the body does not expel it 

• Incomplete miscarriage: some of the tissue from the embryo or placenta is passed while some remains inside your body. 

• Complete miscarriage: the embryo and pregnancy tissues are expelled completely from the body. 

• Threatened miscarriage: symptoms like bleeding and cramping make a future miscarriage likely. 

• Inevitable miscarriage: bleeding and cramps, along with dilation of the miscarriage, indicate that a miscarriage will occur. 

• Septic miscarriage: a uterine infection tied to a miscarriage. 

It is important to see your doctor for all types of miscarriages, even if you believe you have had a complete miscarriage and passed all pregnancy tissue.

Unless the miscarriage is linked to something like unmanaged diabetes, which can be controlled with treatment and lifestyle changes, miscarriage can rarely be prevented. However, there are things you can do to stay healthy during pregnancy and promote the health of your developing baby. Such as: 

• Seeing your doctor for regular prenatal check-ups and care

• Stopping smoking and avoiding alcohol and drugs

• Maintain a healthy weight 

• Keep away from illness and infections

• Eat a well-rounded, healthy diet

• Take prenatal vitamins and supplements

• Limit caffeine intake 

Just because you forgot to take your prenatal one day or had an extra cup of coffee does not mean you will have a miscarriage. Having a miscarriage doesn't necessarily mean you won't go on to have a healthy pregnancy in the future. 

What happens if you do have a miscarriage? You will need to be evaluated by your doctor as the treatment depends on the type of miscarriage you experience. A complete miscarriage in which your body expels all pregnancy tissue often doesn't require any sort of treatment. You will still likely need to be monitored by your doctor to ensure all the tissue passes. 

If your body does retain tissue, treatment will generally be required. There are different options in this case: 

• Expectant management: A watch-and-wait treatment where your doctor monitors you, watching for the rest of the tissue to be passed from your body. 

• Medical management: You can take medication that will help your body expel any remaining tissue. Usually, this is misoprostol (Cytotec) which can trigger cramps to help the uterus pass the tissue. 

• Surgical management: Remaining tissue is surgically removed. This is often known as a Dilation and curettage, or D&C, in which the cervix is dilated so that the contents of the uterus and the uterine lining may be surgically removed. 

There are very minor risks to the type of treatment your doctor proposes. It's important to note that even after your body no longer contains pregnancy tissues, there can be lasting wounds in the form of mental and emotional trauma. Just because your miscarriage is complete does not mean that you have to feel healed or that others should view you as healed. 

A miscarriage is a traumatic event that can take longer to heal from emotionally than physically. Pregnancy loss can be devastating, no matter the type of miscarriage or when in your pregnancy it occurred. Ways that you can take care of your emotional and mental health include: 

• Allowing yourself to grieve. Giving yourself space to grieve and honor your baby's life is an important step. Miscarriage is a true loss that deserves to be acknowledged however you choose to do so. 

• Talk or journal. Sharing your experience can help. You can talk with others who will listen and support you. Connecting with others who experienced a miscarriage can also be beneficial. If you don't feel like sharing with others, journaling is a private way to work through feelings and thoughts. 

• Let go of your guilt. Miscarriage can make some feel guilty as if they were responsible for the pregnancy loss. Miscarriage often can't be prevented, and you likely had little to no control over the loss. Remind yourself that you are not the cause and that you were a wonderful home to your little one, no matter how short a time. 

• Slowly return to things. When you are ready physically, emotionally, and mentally, slowly ease back into things. Start with things that you enjoy, such as self-care, spending time outside, or hanging with your friends. Surround yourself with happiness and positivity, not feeling obligated to engage with things or those who don't serve you. 

The emotional and physical process of recovering from a miscarriage can be challenging; take it slow and give yourself grace. 

Many couples want to know when they can begin trying to conceive again after a miscarriage. Regardless of the type of miscarriage, intercourse usually isn't advised for at least two weeks to prevent the risk of infection. In most cases, it is around this time that you can ovulate and become pregnant. 

Though remember, even if your body is physically ready, you may not be emotionally ready. Be sure to communicate your feelings with your partner. After one miscarriage, you can usually start trying as soon as your doctor clears you. Two or more miscarriages may necessitate medical testing before you try again. This can help rule out any underlying conditions and better allow your doctor to care for you in subsequent pregnancies. 

Just as there is nothing that can usually be done to prevent a miscarriage, there is no guaranteed way to ensure a future healthy pregnancy. It's often recommended to create a healthy space for your baby by eating a healthy diet, taking your prenatal vitamins, and getting light to moderate physical activity. 

Some women may wish to optimize their wombs using natural supplements. The herbs in Osh Wellness Womb Rebalance were selected because they support women after miscarriage. Shatavari encourages hormonal balance and a return to regular menstrual cycles. Moringa is packed with nutrients to fortify the uterus, while Chaste Tree Berry supports egg health. Nettles may help increase the number of oocytes, oocyte quality, and fertilization rate. Red Clover can fight inflammation and encourage healing. These Ayurveda-inspired superfoods are ideal for those who are post-miscarriage and looking to promote uterine health. 

When you do become pregnant, you will likely experience a range of emotions. You undoubtedly be excited but probably a little anxious too. Some women feel that becoming pregnant again is a healing and validating experience. Others struggle with anxiety and depression that may last past the healthy birth of a baby. Even when you become pregnant, it's important to talk about your feelings and concerns with your support system, including your partner, friends, family, and doctor. 

If you have experienced a miscarriage, we're sorry for your loss. Your baby and your pregnancy are important, no matter how long you got to spend with them. You can be hopeful and sad simultaneously, and you can take as long as you need to decide to try again. Know that you are not alone in experiencing miscarriage, even though knowing the statistics doesn't always help. We hope that you find the support and care you need, and we are always there to help 💛.