The most common symptom of miscarriage is vaginal bleeding, but there are other signs of miscarriage to be aware of. Contact your GP, midwife or nearest Early Pregnancy Unit if you think you are having a miscarriage.
Vaginal bleeding is the most common symptom of miscarriage. This varies from light spotting or brown discharge, to a heavy bleed that may be heavier than a normal period.
Light bleeding before 12 weeks (during your first trimester) of pregnancy can be quite common and is not always a sign of miscarriage. But you should always contact your midwife or GP straight away if you have any bleeding, with or without pain, at any point in your pregnancy.
Bleeding in pregnancy after 12 weeks is not common. Contact A&E or your hospital maternity unit immediately so you can be checked.
If you are bleeding, use a clean sanitary pad. Do not use tampons, because they can increase the risk of infection. It’s a good idea to monitor the bleeding and make a note of what it is like, so you can tell your healthcare professional.
Stomach (abdominal) pain or cramping
Some pain and very light cramps in the stomach (abdominal) area in early pregnancy is not unusual. Mild stomach pain in early pregnancy (during your first trimester) is usually caused by your womb expanding, the ligaments stretching as your bump grows, hormones, constipation or trapped wind.
However, cramping and pain in your lower tummy may be caused by a miscarriage. If you have any concerns about any pains you’re having, or even if you just feel like something is wrong, contact your midwife.
Do not be concerned about wasting anyone’s time. It’s always best to get things checked out.
Find out more about stomach pain in pregnancy.
Other miscarriage symptoms
When you are experiencing a miscarriage, you may also notice the following symptoms:
a discharge of fluid from your vagina
a discharge of tissue from your vagina
no longer experiencing pregnancy symptoms, such as feeling sick and tender breasts (although these symptoms may lessen or go away after the first trimester)
When to get checked
If you notice any of the symptoms listed above, especially vaginal bleeding or pain, you should contact your GP, midwife or nearest Early Pregnancy Unit straight away. You can also call the NHS 111 at any time of day or night.
Missed (or delayed) miscarriage
Some women do not have any symptoms that show they are having a miscarriage. This is called a missed miscarriage. In this case, women usually find out when they attend a routine antenatal appointment as it may not be possible to find the baby’s heartbeat during the ultrasound scan.
Some miscarriages are caused by a pregnancy that develops outside of the womb. This is called an ectopic pregnancy. Symptoms of an ectopic pregnancy usually appear between weeks 4 and 12.
You should seek medical advice immediately if you notice any of the following symptoms:
persistent and severe tummy pain, usually on one side
vaginal bleeding or spotting, commonly after the pain has started
pain in your shoulder tip
diarrhoea and vomiting
feeling very faint and lightheaded, and possibly fainting.
Call 999 for an ambulance or visit your nearest A&E department if you:
have sharp, sudden and intense stomach pains
feel very dizzy or faint
look very pale.
Research into why miscarriage happens
Most of the miscarriage research carried out in the UK happens in the Tommy's National Centre for Miscarriage Research, which only opened in 2016. Historically there has been a lack of research into miscarriage and because of this the causes are still not very well understood. The animation below shows the progress into understanding the reasons for miscarriage, particularly miscarriage that is not caused by chromosomal abnormalities.
Reviewed: 17 April 2020 | Next review: 17 April 2023
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Early Signs of Miscarriage (and When Not to Panic) – Cleveland Clinic Health Essentials
You just found out you’re pregnant, and now you’re spotting. Should you panic? Not if it’s just spotting, says Ob/Gyn Kathleen Berkowitz, MD. “There are a lot of reasons why this can happen in early pregnancy,” she says. “One reason is that the placenta is beginning to implant and establish vascular connections to the uterus.”
What to do if you’re spotting
You’re at the highest risk of miscarriage around four to six weeks after your last normal menstrual period, but as long as the spotting (that’s defined as light bleeding) doesn’t become heavy, you can relax.
“You don’t need to do anything right away,” says Dr. Berkowitz. “Once a fetus’s heart rate is established (around six to eight weeks), the risk of a miscarriage goes down significantly.” And as long as you’re not bleeding or cramping, you’ll typically have your first ultrasound around 12 to 14 weeks.
It’s normal to be worried about other symptoms too.
A lot of pregnant people are concerned if all of a sudden their fatigue level or their nauseousness improves, but those are things that are going to get better anyway as the pregnancy gets past 10 to 12 weeks.
When to call your doctor
Heavy bleeding accompanied by cramps is the most common sign of miscarriage, says Dr. Berkowitz. “If you’re cramping and bleeding, especially if you’ve had any medical problems that aren’t under control or prior surgery on your fallopian tubes or uterus, you need to see your doctor right away.” You may also have abdominal pain and lower backache.
What causes miscarriage?
“Especially in the first trimester, about 60% to 70% of miscarriages are due to the chromosomes not lining up right,” Dr. Berkowitz says. “That’s not something that’s likely to continue happening pregnancy after pregnancy for most people, but it’s much more common if you’re over the age of 35.”
The second most common cause is having another medical condition such as diabetes, accounting for around 5% to 7% of miscarriages, says Dr. Berkowitz. “With the other cases, many times we don’t know, though smoking can be a contributor as well.”
It’s uncommon, but “if you’ve had two miscarriages with the same partner and no live births, or three miscarriages with the same partner and a living child, there’s a possibility that there may be a misarrangement of the chromosomes for one of the partners,” Dr. Berkowitz says. “Somewhere around 5% of couples who experience recurrent miscarriage will be found to have this misalignment.”
What puts you at risk for miscarriage?
Being over the age of 35 puts you at a higher risk for miscarriage because chromosomal abnormalities are more common with age. Having an uncontrolled or untreated medical condition like diabetes, heart disease, kidney disease or a thyroid disorder is another risk factor.
“Getting your medical conditions under control and planning for pregnancy is very important to improve your ability to have a successful pregnancy,” says Dr. Berkowitz. “If you haven’t gone for a recent physical, you may have a condition that needs to be managed to help you have a more successful pregnancy.”
How is miscarriage diagnosed and treated?
Concern about bleeding is the number one reason Dr. Berkowitz gets referrals to evaluate patients’ pregnancy status. First, she reviews any other medical conditions the patient has to see if there’s treatment for those that might help. Next, she does an ultrasound to check for possible causes of the bleeding, such as a fibroid or an abnormality in the uterus.
If they’re available, she also compares the patient’s original hCG (the pregnancy hormone) levels to the ultrasound and when the patient thinks she conceived. “When I’ve got those pieces of information, I can put together a timeline for the patient on what should happen over the next one to three weeks and let her know at least what sort of follow-up we’ll be able to give her,” says Dr. Berkowitz.
Though it can be extremely difficult, patience is a virtue when it comes to a potential miscarriage. “Unfortunately, because most of these miscarriages are chromosomal misalignments, we simply don’t have any treatment to fix them or prevent them from happening,” Dr. Berkowitz says. “In some of these cases with bleeding, you just need some time to go by to see how the pregnancy is going to progress. And waiting is tough.”
Don’t blame yourself
Though many women blame themselves for a miscarriage, “in the majority of cases, it has nothing to do with what you did or didn’t do,” assures Dr. Berkowitz. “It’s usually because the chromosomes simply didn’t line up right and that isn’t under anyone’s control.” Talk to your doctor if you’re concerned about your role in a miscarriage, advises Dr. Berkowitz. They can give you reassurance and advice for the next time.
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A miscarriage is always associated with severe consequences for the whole body of a woman and for her reproductive organs in particular, it also affects the family situation, disrupts the woman's work schedule. An unfavorable outcome of pregnancy requires great mental and physical costs on the part of parents. Therefore, contacting doctors to find out the causes of the problem is the very first and correct step towards the birth of a child.
Any competent gynecologist will tell you that the problem of miscarriage can be solved. With proper preparation for pregnancy and its management, the next time you will have a successful pregnancy. Most girls after a miscarriage go to extremes: they try to get pregnant again as soon as possible. And if this succeeds, then the miscarriage is very often repeated. And you need to give the body a rest for 2-3 months, then identify and eliminate the cause. And only then try.
Causes of miscarriage
Many are convinced that miscarriages are due to a fall, bruise, or some other physical shock. Any woman who has had a miscarriage can remember that not long before she either fell or lifted something heavy. And I am sure that she lost her unborn child precisely because of this. However, those women whose pregnancy was normal also fall and lift heavy things. Most sudden miscarriages do not occur for this reason. The reason is in violations of the pregnancy itself. Approximately half of miscarriages are due to abnormal genetic development of the fetus, which can be hereditary or accidental. Merciful nature, following the principles of natural selection in everything, destroys the defective and unviable fetus. But you should not be afraid of this. The fact that there is a defect in one embryo does not mean at all that all the others will be the same.
The woman's body is almost always to blame for the other half of miscarriages. They are caused by various known and unknown factors, such as: acute infectious diseases suffered in the first trimester of pregnancy, poor environment or difficult working conditions, excessive psychological or physical stress, abnormal development of the uterus, radiation, alcohol, smoking and certain types of drugs.
The causes of early and late miscarriage may differ, although they may overlap. The most important thing is to find out and eliminate or compensate for your own cause of miscarriage. Having discovered the cause, the gynecologist will tell you how to avoid another loss.
Miscarriage statistics also include “missed pregnancy”. Sometimes it happens that the embryo dies and lingers in the uterine cavity. Most often, this fact is detected by ultrasound. The dead fetus may begin to decompose, and this, thereby, will lead to poisoning of the mother's body.
Doctors resort to surgical curettage, which is associated with a risk of inflammation and complications. With such a miscarriage, the next pregnancy is planned after the body is fully restored - not earlier than a year. During this year, you will have to find out the cause of the missed pregnancy and treat it.
Miscarriage up to 6 weeks
The main causes of miscarriage on this line are malformations of the embryo itself. Statistics say that from 70-90% of embryos had chromosomal abnormalities: they are random and will not occur in other pregnancies. You may have been ill, taken medication, or were under the influence of other harmful factors. Fate saved you from a child with malformations.
The human body is perfect and finds a way to correct the situation by miscarriage. Today is a tragedy for you. The real tragedy would be the preservation and birth of a sick, non-viable child. So don’t cry and understand: everything is for the best, you won’t help grief with tears ... And after three months, try again - it will almost certainly turn out to be successful.
It should also be noted that the fact of a miscarriage does not mean that you have lost something. So for a period of 7-8 weeks, the absence of an embryo in the fetal egg is found - "anembryony". It is believed that in 80-90% of cases, miscarriages are undiagnosed non-developing pregnancies.
Miscarriage between 6 and 12 weeks
Miscarriage in this period is also considered early. Its most common causes are:
Endocrine disorders, when the ovaries do not synthesize enough hormones to keep the fetus in the womb, or the amount of male sex hormones is increased, is one of the most common causes of miscarriage and miscarriage.
Imbalance of hormones in a woman's body is very likely to lead to an early termination of pregnancy. With a lack of the main hormone progesterone produced by the ovaries, this happens most often. Another hormonal problem is an increase in the tone of the uterus, which provokes the expulsion of the fetus.
Progesterone prepares the uterine mucosa for implantation and is the hormone for maintaining pregnancy in the first months. If conception occurs, the fetus cannot properly establish itself in the uterus. As a result, the fertilized egg is rejected. But pregnancy can be saved with the help of progesterone preparations if this problem is detected in time.
An excess of male sex hormones that suppress the production of estrogen and progesterone can also be the cause of an early miscarriage. Often, the cause of recurrent miscarriages are androgens that affect the formation and development of pregnancy; as well as thyroid and adrenal hormones. Therefore, a change in the function of these glands can lead to miscarriage.
Undertreated sexual infections
This problem must be solved before conception. Often the cause of miscarriage is sexually transmitted infections: syphilis, trichomoniasis, toxoplasmosis, chlamydia, cytomegalovirus and herpetic infections. Their effect on the fetus and the course of pregnancy is different for each woman and depends on the timing of infection, the activity of the microorganism, the degree of immune protection and the presence of other adverse factors. Depending on the situation, they can lead to the formation of fetal malformations, intrauterine infection, feto-placental insufficiency, early miscarriage or premature birth. Infection of the fetus and damage to the membrane of the fetus leads to miscarriage. To avoid this, infections should be treated before pregnancy. The use of therapy is possible during pregnancy as prescribed by a doctor.
Viral infections and other diseases
Any disease accompanied by intoxication and fever above 38 about C can lead to a miscarriage. Rubella, influenza and viral hepatitis occupy a leading position in this list. At a period of 4-10 weeks for pregnancy, ordinary tonsillitis can also become tragic, pneumonia carries a more serious risk. Pyelonephritis and appendicitis can cause early labor. When planning a pregnancy, it is imperative to undergo a medical examination in order to identify and treat foci of infections.
Extremely dangerous during pregnancy rubella - it leads to severe fetal malformations, so infection during pregnancy is an indication for medical abortion.
Any disease during pregnancy can lead to non-viability of the fetus. And the body, through a miscarriage, insures you against unwanted offspring. With such a miscarriage, the next pregnancy has every chance of going well.
Immune causes of miscarriage
Sometimes antibodies that are hostile to the fetus are formed in the blood of a pregnant woman. This cause can be predicted and eliminated in advance. Most often, the conflict occurs when the embryo inherits the positive Rh factor of the father, and the negative Rh factor, the mother's body rejects the embryonic tissues that are alien to it. Constant monitoring of antibody titer and the introduction of anti-Rhesus immunoglobulins allows you to maintain and maintain pregnancy. In case of an immune conflict, progesterone preparations are also used to prevent miscarriage, which in this case has an immunomodulatory effect.
Reduced immunity during pregnancy also refers to immune causes. The body is simply not able to grow a new life in itself. You need to take care of yourself and recover before the next conception.
Anatomical causes of miscarriage
Anatomical causes of miscarriage are the most intractable. Malformations of the uterus are a serious reason for miscarriage. Sometimes you just have to deal with it.
Miscarriage between 12 and 22 weeks
Such a miscarriage is considered late. Its causes coincide with the causes of miscarriages in the early stages (anatomical, immune, infectious, endocrine).
At this time, miscarriage also occurs due to isthmic-cervical insufficiency - a weak cervix cannot hold the fetus and opens. For this reason, a miscarriage can occur in the 2nd or 3rd trimester. Isthmic-cervical insufficiency is observed in 15.0-42.7% of women suffering from miscarriage. Careful monitoring of the pregnant woman allows you to identify the problem in time and make surgical correction of the cervix before the onset of childbirth.
In isthmic-cervical insufficiency, there is only one method of treatment - mechanical narrowing of the cervical canal. To do this, the neck is either sewn up or a special ring is put on it. However, the latter method is less efficient, because the ring can easily slide off the neck, then it will no longer hold back the process of opening it.
After suturing, if necessary, it is possible to use antibiotics and drugs that normalize the microflora of the vagina. The treatment of the vagina and the control of the state of the seams are carried out daily for 5 days. Stitches are removed at 37-38 weeks and with premature onset of labor.
Isthmic-cervical insufficiency may be primary (for no apparent reason), may be the result of abortion or hormonal disorders (increased levels of androgens - male sex hormones or their precursors).
Miscarriage after 22 weeks
Such a loss is hard to forget. Obstetricians talk about premature birth after the 28th week of pregnancy. Traditionally, a child born after this period is considered viable. But medicine knows many cases when it was possible to save the life of earlier children.
We recommend that you be carefully examined for miscarriage, check the above factors. In addition to them, the cause of a miscarriage can be antiphospholipid syndrome, while the woman's body perceives the child as something alien and rejects it. This disease, like the others listed, can be corrected; you have a very real chance of bearing a child.
Miscarriages due to hemostasis disorders
All of the above causes account for only 30-40%. Up to 70% of miscarriages are caused by disorders in the blood coagulation system (hemostasis).
Blood coagulation disorders leading to pregnancy loss can be divided into thrombophilic (increased clotting) and hemorrhagic (bleeding tendencies). Both of these extremes are dangerous to the fetus. Various disorders leading to the formation of small blood clots lead to the fact that the fetus loses sufficient blood supply, development is disturbed and the fetus is rejected.
The main hemorrhagic changes can appear even in childhood in the form of increased bleeding during cuts, tooth extractions, the onset of menstruation. But sometimes they declare themselves only during pregnancy and are the cause of a miscarriage. Bleeding in the early stages and detachment of the chorion is difficult to stop.
You may not guess, but incomprehensible headaches, weakness, fatigue, temporary loss of smell or hearing may be symptoms of disorders in the blood coagulation system.
When planning a pregnancy, a genetic examination should be carried out and, if necessary, treatment should be started.
It is advisable to be examined for hidden hemostasis defects even for those who consider themselves healthy. This will allow you to predict the occurrence of complications and prevent loss. Early therapy can prevent miscarriage at 98% of cases. If defects in hemostasis are already detected during pregnancy, it can be difficult to maintain it.
What to do after a miscarriage?
Find the cause! The ideal option is to be examined by future parents: it is much more reasonable to postpone conception and spend two or three months to identify the causes than to risk getting pregnant again, spend two months waiting, and then lose everything again and still go to the doctors.
Until you understand the reason, it will not evaporate. In most cases, the answers lie on the surface. Take care of your health and your future baby.
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Spontaneous miscarriage and miscarriage
Over the past 10 years, the number of spontaneous miscarriages has been growing rapidly. The International Histological Classification Organization (FIGO) has declared an epidemic of the situation with an increase in the frequency of miscarriages.
Spontaneous miscarriage is the termination of pregnancy before the fetus reaches a viable term (up to 22 weeks of pregnancy and fetal weight 500g.). Most miscarriages (about 80%) occur before 12 weeks of gestation. Moreover, in the early stages up to 8 weeks of pregnancy, the cause of miscarriage is chromosomal abnormalities in 50% of cases. It turns out that nature eliminates the defective product of conception. And these causes are difficult to prevent, especially in the presence of hereditary diseases. Fortunately, accidental breakdowns are much more common than genetically determined ones. Therefore, subsequent pregnancies usually end happily. But the remaining 50% of miscarriages have completely real and removable causes. They can be easily identified at the stage of preparation for pregnancy by a gynecologist.
What are the reasons?
- chronic diseases: inflammatory diseases of the uterus and appendages, polycystic ovary syndrome, uterine fibroids, endometriosis, malformations of the genital organs. - infections: toxoplasmosis, listeriosis, genital tuberculosis, sexual infections - chlamydia, mycoplasma, ureaplasma, syphilis. - antiphospholipid syndrome. - endocrine diseases: diabetes, thyroid disease. - metabolic disorders in the body: obesity, folic acid deficiency, iron deficiency, vitamin D deficiency. - male factor. Of course, these causes are identified and eliminated before the planned conception.
There are harmful factors that can affect the development of the fetus in the early stages of pregnancy and lead to miscarriage:
- alcohol consumption. - use of caffeine (4-5 cups of coffee per day). - smoking (more than 10 cigarettes per day). - drug use. - taking medications with a teratogenic effect (for example: aspirin, nise and others from this group of drugs; antifungals; antidepressants; some antibiotics and a number of other drugs). - toxins and occupational hazards: ionizing radiation, pesticides, inhalation of anesthetic gases.
What are the signs of possible pregnancy loss?
These are complaints of pain in the lower abdomen and lower back, bloody discharge from the genital tract. It is necessary to consult a doctor to rule out an ectopic pregnancy and conduct an additional examination (hCG test, blood test for progesterone, ultrasound). In early pregnancy, with dubious ultrasound data or suspected non-developing (missing) pregnancy, expectant management is chosen with a repetition of a gynecologist's examination, ultrasound, tests after 7-10 days. If a the diagnosis was made and the fact of uterine pregnancy was confirmed, with a threatened miscarriage, preservation therapy is carried out in an outpatient day hospital. A miscarriage that has begun requires hospitalization in the gynecological department. In the case of a non-developing pregnancy, an abortion is performed.
In accordance with the clinical treatment protocol approved by the Ministry of Health of the Russian Federation dated 07.06.2016. Preference is given to drug therapy aimed at terminating pregnancy with prostaglandin analogues (misoprostol) with or without prior use of an antiprogestin (mifepristone). In case of need for surgical treatment (with incomplete miscarriage with infected miscarriage), it is recommended to use aspiration curettage (with an electric vacuum source or a manual vacuum aspirator). What has a significant advantage over curettage of the uterine cavity because it is less traumatic and can be performed on an outpatient basis.
All women who have had a miscarriage need treatment to prevent complications and prevent recurrent miscarriages. Why is rehabilitation therapy necessary?
According to the decision of the XVIII World Congress of Obstetricians and Gynecologists , the diagnosis of chronic endometritis should be made to absolutely all women who have had an undeveloped pregnancy. Two out of three miscarriages according to Professor V.E. Radzinsky are caused by this disease. When examining the material from the uterine cavity, infectious pathogens were isolated: ureaplasmas, mycoplasmas, streptococci, staphylococci, Escherichia coli, viruses (herpes, HPV). Therefore, it is very important to carry out treatment immediately after the termination of pregnancy. If time is lost, it is necessary to carry out additional diagnostics: a pipel biopsy of the endometrium with a histological examination and a study for infections, including tuberculosis. Then, taking into account the results obtained, symptomatic anti-inflammatory therapy is carried out (immunomodulators, antibacterial drugs, physiotherapy, gynecological massage, mud therapy). In parallel, an examination is prescribed to identify other causes of miscarriage (male factor, chronic maternal diseases, genital infections, antiphospholipid syndrome). In the medical center "Mifra-Med" at the level of modern requirements of medicine, all the possibilities of a complete adequate examination have been created: all types of tests, ultrasound, hysteroscopy, aspiration biopsy, consultations of narrow specialists (endocrinologist, therapist, neurologist, urologist).