Miscarriage is a term used for a pregnancy that ends on its own, within the first 20 weeks of gestation. The medical terms used to identify this potential complication or loss gives most women an uncomfortable feeling, so throughout this article, we will refer to this type of threatened complication or pregnancy loss under 20 weeks as a miscarriage.
Miscarriage is the most common type of pregnancy loss, according to the American College of Obstetricians and Gynecologists (ACOG). Studies reveal that anywhere from 10-25% of all clinically recognized pregnancies will end in miscarriage. Chemical pregnancies may account for 50-75% of all miscarriages. This occurs when a pregnancy is lost shortly after implantation, resulting in bleeding that occurs around the time of her expected period. The woman may not realize that she conceived when she experiences a chemical pregnancy.
Most miscarriages occur during the first 13 weeks of pregnancy. Pregnancy can be such an exciting time, but with the great number of recognized miscarriages that occur, it is beneficial to be informed about miscarriage, in the unfortunate event that you find yourself or someone you know faced with one.
There can be many confusing terms and moments that accompany a miscarriage. There are different types of miscarriage, different treatments for each, and different statistics for what your chances are of having one. The following information gives a broad overview of miscarriage. This information is provided to help equip you with knowledge so that you might not feel so alone or lost if you face a possible miscarriage situation. As with most pregnancy complications, remember that the best person you can usually talk to and ask questions of is your health-care provider.
Ways that we can help. If you are concerned or have questions about miscarriage, you are welcome to contact our helpline at 1-800-672-2296. You are welcome to alert our prayer team by sending an email to ( prayers @ americanpregnancy.org ). Explore the article below to find answers to common questions.
Why Do Miscarriages Occur?
The reason for miscarriage is varied, and most often the cause cannot be identified. During the first trimester, the most common cause of miscarriage is chromosomal abnormality – meaning that something is not correct with the baby’s chromosomes. Most chromosomal abnormalities are the cause of a damaged egg or sperm cell or are due to a problem at the time that the zygote went through the division process.
Other causes of miscarriage include (but are not limited to):
- Hormonal problems, infections or maternal health problems
- Lifestyle (i.e. smoking, drug use, malnutrition, excessive caffeine and exposure to radiation or toxic substances)
- Implantation of the egg into the uterine lining does not occur properly
- Maternal age
- Maternal trauma
Factors that are not proven to cause miscarriage are sex, working outside the home (unless in a harmful environment) or moderate exercise.
What Are The Chances of Having a Miscarriage?
For women in their childbearing years, the chances of having a miscarriage can range from 10-25%, and in most healthy women the average is about a 15-20% chance.
- An increase in maternal age affects the chances of miscarriage
- Women under the age of 35 yrs old have about a 15% chance of miscarriage
- Women who are 35-45 yrs old have a 20-35% chance of miscarriage
- Women over the age of 45 can have up to a 50% chance of miscarriage
- A woman who has had a previous miscarriage has a 25% chance of having another (only a slightly elevated risk than for someone who has not had a previous miscarriage)
Miscarriage Warning Signs
If you experience any or all of these symptoms, it is important to contact your health care provider or a medical facility to evaluate if you could be having a miscarriage:
- Mild to severe back pain (often worse than normal menstrual cramps)
- Weight loss
- White-pink mucus
- True contractions (very painful happening every 5-20 minutes)
- Brown or bright red bleeding with or without cramps (20-30% of all pregnancies can experience some bleeding in early pregnancy, with about 50% of those resulting in normal pregnancies)
- Tissue with clot like material passing from the vagina
- Sudden decrease in signs of pregnancy
The Different Types of Miscarriage
Miscarriage is often a process and not a single event. There are many different stages or types of miscarriage. There is also a lot of information to learn about healthy fetal development so that you might get a better idea of what is going on with your pregnancy. Understanding the early fetal development and first-trimester development can help you to know what things your health care provider is looking for when there is a possible miscarriage occurring.
Most of the time all types of miscarriage are just called a miscarriage, but you may hear your health care provider refer to other terms or names according to what is experienced.
- Threatened Miscarriage: Some degree of early pregnancy uterine bleeding accompanied by cramping or lower backache. The cervix remains closed. This bleeding is often the result of implantation.
- Inevitable or Incomplete Miscarriage: Abdominal or back pain accompanied by bleeding with an open cervix. Miscarriage is inevitable when there is a dilation or effacement of the cervix and/or there is rupture of the membranes. Bleeding and cramps may persist if the miscarriage is not complete.
- Complete Miscarriage: A completed miscarriage is when the embryo or products of conception have emptied out of the uterus. Bleeding should subside quickly, as should any pain or cramping. A completed miscarriage can be confirmed by an ultrasound or by having a surgical curettage (D&C) performed.
- Missed Miscarriage: Women can experience a miscarriage without knowing it. A missed miscarriage is when embryonic death has occurred but there is not any expulsion of the embryo. It is not known why this occurs. Signs of this would be a loss of pregnancy symptoms and the absence of fetal heart tones found on an ultrasound.
- Recurrent Miscarriage (RM): Defined as 3 or more consecutive first trimester miscarriages. This can affect 1% of couples trying to conceive.
- Blighted Ovum: Also called an embryonic pregnancy. A fertilized egg implants into the uterine wall, but fetal development never begins. Often there is a gestational sac with or without a yolk sac, but there is an absence of fetal growth.
- Ectopic Pregnancy: A fertilized egg implants itself in places other than the uterus, most commonly the fallopian tube. Treatment is needed immediately to stop the development of the implanted egg. If not treated rapidly, this could end in serious maternal complications.
- Molar Pregnancy: The result of a genetic error during the fertilization process that leads to the growth of abnormal tissue within the uterus. Molar pregnancies rarely involve a developing embryo, but often entail the most common symptoms of pregnancy including a missed period, positive pregnancy test and severe nausea.
Emotional Treatment for a Miscarriage
Unfortunately, miscarriage can affect anyone. Women are often left with unanswered questions regarding their physical recovery, their emotional recovery and trying to conceive again. It is very important that women try to keep the lines of communication open with family, friends and health care providers during this time.
Some helpful websites that address miscarriage and pregnancy loss include:
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Last updated: December 5, 2017 at 11:10 am
Compiled using information from the following sources:
1. Current Obstetric & Gynecologic Diagnosis & Treatment Ninth Ed. DeCherney, Alan H., et al, Ch. 14.MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2006 Feb 23]. Pregnancy Loss; [updated 2006 Feb 22; reviewed 2006 Feb 7; cited 2006 Feb 23].
2. Planning Your Pregnancy and Birth Third Ed. The American College of Obstetricians and Gynecologists, Ch. 15.
Williams Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 9
Testing for Causes of Recurrent Miscarriages
There are many tests that can be done to help determine the cause for recurrent miscarriages. It can be both scary (not finding the cause) and hopeful (getting a diagnosis) to get testing. Just remember you may find the cause of the miscarriages and be able to move forward with treatment and the knowledge of how to take care of yourself during pregnancy. If no cause is found – know that 70% of couples who experience recurrent miscarriages without a known cause do go on to have a healthy successful pregnancy.
Make sure to find a reproductive endocrinologist that is supportive of testing and up to date with all the research being done for recurrent miscarriages, even before your third miscarriage. I have listed the most common tests below. This list is not inclusive, but rather is a general guide to help you begin your learning.
Hysterosalpingogram (HSG)This is an x-ray test of the uterus. A dye is injected into the uterus and x-rays are taken to see the shape of the uterus, blockages of the tubes, growths and other abnormalities that could cause infertility or miscarriages. This is a painful test, but a very revealing one. An HSG is generally the first test that is done when you go to see an RE (Reproductive Endocrinologist).
Autoimmune testingAntiphospholipid syndrome (APS) is an autoimmune imbalance which causes the body’s immune system to react to certain normal substances in the blood which can increase the chance of forming blood clots. It is estimated that 10% – 25% of women with recurrent miscarriages have APS, making testing very important. Speak to your doctor about referring you to a specialist for an antiphospholipid antibody (APA) test. A positive test result for any part of this test indicates there may be other immune problems and according to Dr. Alan Beer, “…there is a 50% likelihood of elevated NK cells or Th1:T2 cytokine ratios.”
Doctors will generally treat this condition with low-dose baby aspirin and injections of heparin (blood thinner) during pregnancy.
Prothrombin TimeThis is a test to see how fast the blood clots.
Thyroid PanelHypothyroidism has been linked to miscarriages during all trimesters. Not all doctors will do a thyroid panel test, make sure to ask and work with a doctor that is supportive and up to date on thyroid issues. In the Journal of Medical Screening (Sept. 2000) doctors reported that by screening for thyroid problems before and during pregnancy, miscarriages could be reduced. Women with hypothyroidism have 4 times the risk of a second trimester miscarriage.
- Understanding Thyroid (TSH) numbers.3 to 3.0 TSH levels are considered the narrower normal range that many experts are using for diagnosis and management of hypothyroidism. Some endocrinologists believe that a percentage of women may find it difficult to get pregnant — or maintain a pregnancy — at a TSH level above 2.0. This is one condition that is best treated with thyroid hormone medication. You will also need to be monitored throughout pregnancy to make sure your levels are within the normal range and medication is adjusted regularly. The medications used to treat hypothyroidism are safe to be taken during pregnancy.
ProgesteroneAdequate progesterone levels are critical for maintaining a healthy pregnancy. Low progesterone levels have been linked to miscarriages. Generally, you are tested around day 21 of a 28-day cycle to determine what your progesterone level is at. You can get blood testing done by visiting an RE or by saliva testing through an online lab.
KaryotypingA type of test to examine chromosomes for genetic issues. This test is best performed on both parents.
- Fetal Tissue TestingIf you are currently going through a miscarriage and choose to have a D&C, you can have karyotyping done on the tissue that is collected to rule out genetic issues. Doctors can perform this test from the following samples: blood, amniotic fluid, or placental tissue.