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August 25, 2022 9 min read
Let’s start simple. What is a miscarriage? A miscarriage is the loss of a pregnancy during the first 23 weeks. The main sign is vaginal bleeding, which may be followed by cramping and pain in your lower abdomen. This can vary from light spotting or brownish discharge to heavy bleeding and bright-red blood or clots. The bleeding may come and go over several days. If you have vaginal bleeding, contact a GP or your midwife. Most GPs can refer you to an early pregnancy unit at your local hospital straight away if necessary. But bear in mind that light vaginal bleeding is relatively common during the first trimester (first 3 months) of pregnancy and does not necessarily mean you're having a miscarriage.Other symptoms of a miscarriage include:
The hospital can carry out tests to confirm whether you're having a miscarriage. The tests can also confirm whether there's still some pregnancy tissue left in your womb (an incomplete or delayed miscarriage) or if all the pregnancy tissue has been passed out of your womb (a complete miscarriage).
The first test used is usually an ultrasound scan to check the development of your baby and look for a heartbeat. In most cases, this is usually carried out using a small probe inserted into the vagina (transvaginal ultrasound). This can feel a little uncomfortable but is not painful.
You may be able to have an external scan of your tummy if you prefer, although this method reduces the accuracy of the scan. Neither type of scan is dangerous to the baby and they do not increase your risk of miscarriage.
You may also be offered blood tests to measure hormones associated with pregnancy. You usually need to have 2 blood tests 48 hours apart to see if your hormone levels go up or down. Sometimes a miscarriage cannot be confirmed immediately using ultrasound or blood testing. If this is the case, you may be advised to have the tests again in 1 or 2 weeks.
If there's no pregnancy tissue left in your womb, no treatment is required.
However, if there's still some pregnancy tissue in your womb, your options are:
The risk of complications is very small for all these options. It's important to discuss them all with the doctor in charge of your care.
If you have a miscarriage in your first trimester, you may choose to wait 7 to 14 days after a miscarriage for the tissue to pass out naturally. This is called expectant management.
If the pain and bleeding have lessened or stopped completely during this time, this usually means the miscarriage has finished. You should be advised to take a home pregnancy test after 3 weeks. If the test shows you're still pregnant, you may need to have further tests.
If the pain and bleeding have not started within 7 to 14 days or are continuing or getting worse, this could mean the miscarriage has not begun or has not finished. In this case, you should be offered another scan.
After this scan, you may decide to either continue waiting for the miscarriage to occur naturally, or have drug treatment or surgery. If you choose to continue to wait, your healthcare professional should check your condition again up to 14 days later.
Contact your hospital immediately if the bleeding becomes particularly heavy, you develop a high temperature (fever) or you experience severe pain.
You may choose to have medicine to remove the tissue if you do not want to wait, or if it does not pass out naturally within 2 weeks. This involves taking tablets that cause the cervix to open, allowing the tissue to pass out. In most cases, you'll be offered tablets called pessaries that are inserted directly into your vagina, where they dissolve. The tablets usually begin to work within a few hours. You'll experience symptoms similar to a heavy period, such as cramping and heavy vaginal bleeding. You may also experience vaginal bleeding for up to 3 weeks. In most units, you'll be sent home for the miscarriage to complete. This is safe, but ring your hospital if the bleeding becomes very heavy.
You should be advised to take a home pregnancy test 3 weeks after taking this medicine. If the pregnancy test shows you're still pregnant, you may need to have further tests. You may be advised to contact your healthcare professional to discuss your options if bleeding has not started within 24 hours of taking the medicine.
Surgery involves removing any remaining tissue in your womb with a suction device. You should be offered a choice of general anaesthetic or local anaesthetic if both are suitable.
A miscarriage can be very upsetting, and you and your partner may need counseling or support. You may also have questions about trying for another baby and what happens to the miscarried fetus. A miscarriage can have a profound emotional impact on you and also on your partner, friends and family.
It's usually possible to arrange a memorial and burial service if you want one. In some hospitals or clinics it may be possible to arrange a burial within the grounds. You can also arrange to have a burial at home, although you may need to consult your local authority before doing so. Cremation is an alternative to burial and can be performed at either the hospital or a local crematorium. However, not all crematoriums provide this service and there will not be any ashes for you to scatter afterwards. You do not need to formally register a miscarriage. However, some hospitals can provide a certificate to mark what has happened if you want one.
Sometimes the emotional impact is felt immediately after the miscarriage, whereas in other cases it can take several weeks. Many people affected by a miscarriage go through a bereavement period. It's common to feel tired, lose your appetite and have difficulty sleeping after a miscarriage. You may also feel a sense of guilt, shock, sadness and anger – sometimes at a partner, or at friends or family members who have had successful pregnancies.
Different people grieve in different ways. Some people find it comforting to talk about their feelings, while others find the subject too painful to discuss. Some people come to terms with their grief after a few weeks of having a miscarriage and start planning for their next pregnancy. For others, the thought of planning another pregnancy is too traumatic, at least in the short term.
If you're in a relationship, it can help to make sure you're both open about how you are feeling. Your partner may also be affected by the loss. Men sometimes find it harder to express their feelings, particularly if they feel their main role is to support the mother and not the other way round. Miscarriage can also cause feelings of anxiety or depression, and can lead to relationship problems.
Most miscarriages are caused by genetic abnormalities in the fetus. Unfortunately, there is nothing that can be done to prevent miscarriages caused by genetic abnormalities.
However, not all miscarriages are caused by genetic abnormalities. If you have had a miscarriage, work with your health care provider to determine the reason for your miscarriage, if possible, and to plan a future pregnancy. A healthy lifestyle before and during pregnancy may help.
Here are some tips that may help prevent miscarriage:
You can also help ensure a healthy baby by finding out about and treating any health conditions you have before you try to conceive. If, for example, you know a previous miscarriage was due to an autoimmune response or a hormonal imbalance, seek treatment for this underlying condition. Once you become pregnant, get early, comprehensive prenatal care to improve your chances of a healthy pregnancy.