First stages of miscarriage

Signs of Early Miscarriage | Obstetrics & Gynecology

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Department of Obstetrics and Gynecology

News | Careers | Giving | UC Davis Health

1. UC Davis Health
2. Obstetrics and Gynecology
3. Miscarriage Management
4. Signs of Early Miscarriage

Early miscarriage refers to loss of a pregnancy in the first trimester. The majority of early miscarriages occur before the pregnancy is 10 weeks gestation. Some miscarriages happen very early, even before a woman is sure she is pregnant.  Still, miscarriage can be a hard and sad experience, no matter when it occurs.

Miscarriage is more common than many people realize. About 10 to 20% of women who learn they are pregnant will have an early miscarriage. The rates of early miscarriage are even higher when women are checking home pregnancy tests very close to the time of their period and are finding a positive test VERY early. By chance alone, 1% to 4% of women will have two miscarriages in a row. However, it is very rare to have 3 or more miscarriages in a row, which is recurrent miscarriage.

In medical terms, early miscarriage is called an early pregnancy failure. This means that the pregnancy failed to develop. Almost all early miscarriages are due to circumstances beyond anyone’s control, and were destined to happen before the woman even knows she is pregnant.

What are the symptoms of early miscarriage?

• Bleeding – light bleeding early in pregnancy is fairly common, and does not mean you will have a miscarriage.
  • Brown discharge: This may look like coffee grounds. This “discharge” is actually old blood that has been in the uterus for a while and is just coming out slowly.
  • Spotting, bright red bleeding or clots
• Passage of tissue through the vagina
• A gush of clear or pink vaginal fluid
• Abdominal pain or cramping
• Pregnancy symptoms, such as breast tenderness and nausea, begin to go away
• Dizziness, lightheadedness, or feeling faint

If you have any symptoms of a miscarriage, you should contact a doctor right away to have an evaluation. It will be important to have an ultrasound exam to look into the uterus to see if the pregnancy is normal or you are having a miscarriage. Even if you think you passed the entire pregnancy and are feeling better, you should see a doctor. Sometimes, passing tissue occurs with an ectopic pregnancy (pregnancy outside of the uterus) which can be life-threatening if not diagnosed early.

Types of early miscarriage

Early miscarriage is a non-medical term for lots of different types of events that might or might not actually result in pregnancy loss. The types of miscarriage include the following:

Spotting or bleeding in the first trimester in which the patient and the doctor are not yet sure if the pregnancy will miscarry or not. About 1/3 of all women will bleed in the first trimester, but only about half of those women will have a miscarriage.

The entire pregnancy is passed from the uterus, most commonly with bleeding and cramping, and no additional treatment or observation is needed.

The pregnancy is definitely miscarrying, but only some of the pregnancy tissue has passed. The tissue that is still in the uterus will eventually pass on its own. Some women may need emergency treatment if there is also heavy vaginal bleeding. Otherwise, women can use medicines to cause the rest of the tissue to pass or simply wait for the rest of the tissue to pass from the uterus.

With this type of miscarriage, the pregnancy implanted but the embryonic tissue (the part of the pregnancy that will develop into a fetus) never developed, or started to develop and then stopped.

With this type of miscarriage, the early embryo (or fetus once 10 weeks pregnant) stops developing and growing.

This is an uncommon type of miscarriage today. With a missed abortion, the pregnancy stops developing but the pregnancy tissue does not pass out of the uterus for at least 4 weeks. Sometimes, dark brown spotting or bleeding occurs, but there is no heavy bleeding.

Some miscarriages occur with an infection in the uterus. This is a serious condition that requires urgent treatment to prevent shock and death. With septic miscarriage, the patient usually develops fever and abdominal pain and may have bleeding and discharge with a foul odor. Antibiotics and suction evacuation of the uterus are important to start as quickly as possible.

What causes early miscarriage?

Almost nothing you can do will cause an early miscarriage. Avoiding sex or heavy work will not impact an early pregnancy. There are a lot of changes that need to occur with the cells and genes in a developing pregnancy, and sometimes those changes do not happen perfectly. There are some health conditions or habits that can increase the chance that an early miscarriage will occur, including:

• Heavy smoking
• Use of illicit drugs, especially cocaine
• Poorly controlled diabetes
• Hyperthyroidism or hypothyroidism
• Physical problems with the uterus, including fibroids or abnormalities of development of the uterus

Why see our specialists at UC Davis Health?

Our specialists can evaluate you quickly in an office setting. Any laboratory testing or ultrasound examinations that need to be done can be performed easily and conveniently. We perform our own ultrasound examination in the office and can share the results with you immediately.

If we do confirm you have a miscarriage, we can discuss expectant management or treatment options with you immediately. Should you need blood testing to evaluate the pregnancy, the laboratory is in the same building as our office.

If you are having very heavy vaginal bleeding or are feeling very sick, you should go to the Emergency Room to see our physicians.

Treatment of early miscarriage

Not all miscarriages “need” treatment. The choice of whether to wait for the pregnancy to completely pass without any treatment is up to you. Our doctors are committed to providing options for all patients, including the pros and cons of all available options when miscarriage is diagnosed. All patients with Rh-negative blood, regardless of which option they choose, need treatment with Rh-immune globulin, an injection that prevents a woman from forming substances in her blood that may attack the baby during a future pregnancy.

When a diagnosis of miscarriage is made, options include:

This means that you will not receive any treatment; just continued follow-up. In an early miscarriage, with time, most women will pass the pregnancy completely. The main issue is time – there is no way to predict exactly when this will occur. You will typically have heavy bleeding and severe abdominal cramping when the pregnancy does pass. Should you want this option, our doctors can review exactly what to expect, how much bleeding is too much bleeding, and what pain medications can be used once the pregnancy begins to pass from the uterus.

This treatment uses medicines to cause the pregnancy tissue to pass from the uterus. The medicines cause cramping and bleeding, just like what will occur with natural passing of the pregnancy tissue. Using the medicines is like expectant management, except that you know when the pregnancy is going to pass. Most women will pass the pregnancy within 24 hours of taking the medication. Similar to expectant management, our doctors can review exactly what to expect, how much bleeding is too much bleeding, and what pain medications to use during treatment. If the pregnancy does not pass, you can repeat the medical treatment, have a suction aspiration, or continue to wait.

• This brief procedure can be done in the office or the operating room. The following steps occur regardless of the location:
• The woman is in the same position as during a regular pelvic exam, like when a Pap test is done.
• A speculum is placed in the vagina
• A cleansing antibacterial solution is applied to the cervix and vagina
• Numbing medicine is applied to the cervix to decrease cramping
• The cervix is dilated (opened) with thin rods; with early miscarriage, the cervix does not need to be opened much to complete the procedure
• A thin straw-like tube is placed through the open cervixThe pregnancy is removed using a mechanical suction pump attached to the tube
• Everything is removed from the vagina when the procedure is done

You may choose to have the procedure in the office or operating room based on your preferences – different women have different needs.
Office procedure:

• A spouse, partner, friend or relative can be in the room with you
• If desired, oral medications can be taken before the procedure to help you feel more relaxed
• You can eat or drink anything you want before the procedure
• The suction used in the office is most commonly a syringe that creates the suction so no noisy machine is used
• You will usually goes home 15-30 minutes after the procedure and can resume relatively normal activities
• Operating room procedure
• The procedure is done in an outpatient operating suite or in the main hospital
• You will be asleep during the procedure
• You cannot eat or drink anything after midnight on the night before the procedure because you will be receiving anesthesia
• You will feel sleepy for the whole day after the procedure and will need someone to be able to drive you home and be with you for the whole day after the procedure
• The operating room is more appropriate for women with certain medical conditions

After treatment for a miscarriage

Bleeding may continue for several weeks after a miscarriage but tends to be much lighter with a suction aspiration. Any bleeding may change in color from bright red to pink or brown. Lower abdominal cramping in the few days after treatment is also common. You should contact a doctor right away if the bleeding gets heavier after the miscarriage instead of lighter, if a fever develops, or if vaginal discharge or a strange or unpleasant vaginal odor occurs. Avoid intercourse, douching, or using tampons for one week. Regular activities can be resumed right away, based on how you feel. Importantly, if you want to delay getting pregnant after the miscarriage, it will be very important to start an effective method of contraception.

Frequently asked questions about miscarriage

Having one miscarriage does not increase your chances of having another. If you have had only one prior miscarriage, the rate of miscarriage in the next pregnancy is similar to the overall rate in the general population. 

No. Working, exercise and sexual activity do not increase the risk of miscarriage.

Patients were told years ago to wait one or two menstrual cycles to wait to get pregnant. We know that it is highly unlikely that any problems occur with a next pregnancy if you get pregnant right away. How soon you decide to try again will depend on whether you want to be pregnant right away and if you feel you need time to recover emotionally from the miscarriage. Ovulation can resume as early as two weeks after a miscarriage, so if you do not want to get pregnant right away, you need effective contraception immediately.

Since most early miscarriages are caused by problems specific to that fertilized egg, and miscarriage overall is relatively common, most experts do not recommend special testing until you have had three early miscarriages (or two miscarriages in women 40 years and older). At that point it is termed "recurrent" miscarriage and further testing may be needed. Studies have shown that even after a woman has experienced three consecutive miscarriages, her chance of the next pregnancy being normal is still about 70%. All women who have a pregnancy loss later in pregnancy should have further testing.

Tips to help support parents after pregnancy loss

UC Davis Health social worker Brenna Rizan, who works within the Department of Obstetrics/Gynecology provides supportive tips and advice for grieving parents, family and friends after pregnancy loss.

Related stories

Miscarriages are more common than people think - KCRA (Interview with Brenna Rizan)

Facebook Live: Discussing miscarriages with Dr. Mitch Creinin

UC Davis Early Pregnancy and Miscarriage Center

• Genetic failures - in the presence of a mutating element in the parental chromosomes, the fetus is expelled from the uterus as incapacitated and contrary to the principles of natural selection of the organism. Various factors can influence the manifestation and development of pathology, it is not always possible to determine them exactly.
• Hormonal imbalance - the cause of miscarriage may be insufficient production of the hormone progesterone, or the predominance of male hormones in the female body. At the stage of preparation for pregnancy, such an anomaly is easily eliminated by the use of hormone therapy. Such measures help to avoid spontaneous abortion at an early stage.
• Rh-conflict of parents - with a negative Rh factor of the mother's blood, the same indicator of the father plays a very important role. With opposite values ​​ early miscarriage is quite possible. If the fetus has a positive Rh factor, then the mother's body seeks to get rid of the foreign body, trying to expel the embryo by any available means. With early diagnosis of an anomaly, the doctor uses progesterone to protect the fetus, which prevents the expulsion of the fetus. If both parents are negative for the Rh factor, then the conflict can be avoided.
• Infectious diseases are a negative factor that can cause harm to the fetus and the body of the expectant mother of various strengths. In the case of genital infections, it is better to get rid of them before the moment of conception, otherwise infection of the embryo is inevitable. It could become cause of miscarriage early pregnancy . Inflammatory processes in the body of a woman are also taken into account. An increase in temperature in response to the harmful effects of the disease is often accompanied by a general intoxication of the body. This takes away the strength of the fetus, so the body easily gives up the embryo without keeping it in the uterus.
• Abortion is a rather complicated operation in terms of the strength of the subsequent impact on the female body. Unprofessional disposal of the fetus can become the cause of miscarriage in the future, and also lead the woman to a complete loss of reproductive function. It is impossible to correct the situation, therefore, doctors, as a rule, communicate for a long time with a woman who has decided to have an abortion in order to convince her to carry out her plan.
• Medicines and medicines - the first trimester of pregnancy is famous for the fact that during this period it is strictly forbidden to take any medicines and drugs. Since vital organs are laid in the embryo, the funds can provoke an anomaly in the development of the child. Also during pregnancy, herbs are prohibited: nettle, tansy, St. John's wort, parsley. Their intake can cause miscarriage and loss of the embryo by the mother's body.
• Mechanical injuries - during pregnancy it is very important to protect yourself from serious physical exertion and possible mechanical damage. From the first days, fitness and other types of physical activity in non-specialized groups are prohibited. In order not to provoke an early miscarriage , it is better to enroll in specialized sports groups for pregnant women, where the load is accurately calculated and only exercises that are harmless to the health of the mother and child are used. You can not lift weights, overexert yourself, be subjected to falls, bumps and unsuccessful loads. Even if the mother is full of health and strength, during pregnancy it is better to beware of careless actions.
• Other factors - unfavorable environment, harmful working conditions, unbalanced diet.

There are also causes of miscarriage based on stress, depression, nervous mood of the future mother. Even at the stage of pregnancy planning, parents should change the usual rhythm of life in order to exclude all negative factors from it. This truth is especially true for women. In order not to provoke an early miscarriage , she must get rid of bad habits, addiction to coffee, alcohol, smoking. She needs to rest more, get enough sleep, eat right and rationally, walk more and breathe fresh air.

Symptoms of a miscarriage - how to determine the termination of pregnancy

The most pronounced signs of spontaneous abortion are pain in the lower abdomen and in the lumbar region, as well as bleeding. Pain symptoms are often spasmodic in nature. They arise suddenly, slowly step aside and after a certain period they roll again. Bloody discharge from the vagina or unstoppable bleeding requires the immediate call of an ambulance team. When observing such signs, there is a high probability of miscarriage in the early stages , so the hospitalization of the expectant mother in such conditions is necessary.

If we compare abundant bleeding and spotting manifestations, then the latter give more chances for the preservation of the fetus. However, it is not worth delaying the call of the doctor in both cases. The consequences can be very serious. If abundant blood flow is accompanied by the presence of clots and pieces of mucous in the fluid, then this indicates a miscarriage that has already occurred.

Often a possible harbinger of termination of pregnancy is a diagnosis made by an obstetrician-gynecologist, indicating a high tone of the uterus. So that the cause of miscarriage does not provoke it, the future woman in labor is advised to remain calm, not to be nervous, not to overwork.

In general, the presence of many of the symptoms listed above is not a panacea for abortion. With timely treatment of a woman to a doctor, further gestation is possible. The only thing that will have to be faced in this case is the careful care of the attending staff of the gynecological consultation.

Treatment of early miscarriage

Bed rest is the main rule for the normal course of pregnancy when there are threats to it. The doctor, excluding any causes of miscarriage , recommends that the future woman in labor lead a measured and calm lifestyle, take care of herself and her own nerves, eat well and give herself little joys, raising her spirits and tuning in to positive. If the threat of losing the child is strong, then the specialist may completely prohibit getting out of bed once again. In this case, ideal conditions can only be achieved in a hospital, which is why pregnant women with a burdened history are often placed in the prenatal ward for preservation.

Psychologists say that the psycho-emotional background of the expectant mother plays one of the leading roles in the process of preparing for childbirth. In order not to provoke a miscarriage at an early stage and at a later period, a woman needs to think about the good and pleasant. It is useful to read your favorite books, listen to soothing music, breathe measuredly and calmly. To prevent you from having the slightest chance of being upset, your doctor may prescribe valerian or motherwort. For pregnant women, they are absolutely harmless. Expectant mothers are encouraged to think positive. About how the baby will be born, what name the parents will give him, how beautiful and strong he will become as he grows up.

If the causes of miscarriage are more significant, the doctor may prescribe hormonal agents that normalize the general background of pregnancy. Medications with a high content of progesterone, anti-hyperandrogenism drugs and reducing the risk of Rhesus conflict pills may be prescribed. If the threat of miscarriage is high, then cervical closure may be used. The sutures are applied under anesthesia, so the procedure is not painful.

Some women have to be under the strict supervision of specialists for the entire period of pregnancy. It happens when possible early miscarriage and later. At the same time, the future woman in labor can be placed in the hospital once, and can also be there on a permanent basis. The reward for strict adherence to the doctor's recommendations is a full-fledged process of pregnancy development and childbirth in due time. A healthy baby who was born can more than compensate for all the inconvenience and discomfort experienced by the parents.

In order to prevent miscarriage, it is recommended that both parents take a balanced approach to the decision to become pregnant. It is necessary to prepare for conception in advance, undergo all the necessary examinations, take the recommended tests. This will eliminate the maximum causes of miscarriage and reduce the risk of developing a negative scenario during pregnancy.

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