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What Does a Miscarriage Look Like? Bleeding, Duration, and More

A miscarriage is a spontaneous pregnancy loss before 20 weeks of gestation. Some 8 to 20 percent known pregnancies end in miscarriage, with the majority happening before the 12th week.

The signs and symptoms of miscarriage vary from person to person. Symptoms may also vary depending on how far along you are. For example, a fetus at 14 weeks will be much larger than a fetus at 5 weeks of gestation, so there may be more bleeding and tissue loss with a later miscarriage.

Miscarriage symptoms may include:

• spotting or bleeding from the vagina
• abdominal cramping or pain in the lower back
• passage of tissue, fluid, or other products from the vagina

Read on to learn more about identifying a miscarriage and what to do if you suspect you’re experiencing one.

Bleeding may start as light spotting, or it could be heavier and appear as a gush of blood. As the cervix dilates to empty, the bleeding becomes heavier.

The heaviest bleeding is generally over within three to five hours from the time heavy bleeding begins. Lighter bleeding may stop and start over one to two weeks before it completely ends.

The color of the blood can range from pink to red to brown. Red blood is fresh blood that leaves the body quickly. Brown blood, on the other hand, is blood that’s been in the uterus a while. You may see discharge the color of coffee grounds, or near black, during a miscarriage.

Exactly how much bleeding you’ll experience depends on a variety of circumstances, including how far along you are and whether or not your miscarriage is progressing naturally.

While you may see a lot of blood, let your doctor know if you fill more than two sanitary pads an hour for two or more hours in a row.

What does a missed miscarriage look like?

You may not experience bleeding or other symptoms with a miscarriage, at least at first.

A missed miscarriage, also referred to as a missed abortion, happens when the fetus has died but the products of conception remain in the uterus. This type of miscarriage is usually diagnosed via ultrasound.

Just as with the amount of blood you’ll see, the duration of a miscarriage will vary from person to person and even from pregnancy to pregnancy.

In many cases, a miscarriage will take around two weeks to pass naturally. Your doctor may prescribe the medication misoprostol (Cytotec) to help a miscarriage pass more quickly. Bleeding may start within two days of beginning the medication. For others, it may take up to two weeks.

Once the miscarriage has started, the tissue and heaviest bleeding should be passed in about three to five hours. After the fetus has passed, you may still experience spotting and mild tissue loss for one to two weeks.

It may be difficult to tell a very early miscarriage from a late period. In fact, many miscarriages happen before a person even knows they’re pregnant.

In general, a miscarriage will cause more intense symptoms than a menstrual period. For example:

• Your menstrual flow may be relatively similar from month to month with heavy days and light days. A miscarriage can also have heavy and light days, but bleeding may be especially heavy at times and last longer than you’re used to.
• Bleeding from a miscarriage may also contain large clots and tissue you don’t normally see during your period.
• Cramps can be a part of your normal monthly cycle, but with a miscarriage, they may be particularly painful as the cervix dilates.
• The color of blood during your period can range from pink to red to brown. If you see a color you’re not used to seeing, it may be a sign of miscarriage.

Always contact your doctor if you’re pregnant and experience bleeding. While a miscarriage can’t be stopped once it starts, you doctor can run tests to help determine if you’re experiencing the loss of your pregnancy or something else.

To diagnose a miscarriage, your doctor will likely perform an ultrasound to look for the baby’s heartbeat, if you’re far enough along to see a heartbeat. Your doctor may also order a blood test to check human chorionic gonadotropin (hcG) levels to see if they’re rising or falling.

If a miscarriage is confirmed, your doctor may suggest “expectant management” or waiting for the miscarriage to pass naturally. This generally happens within two weeks.

Incomplete miscarriage

The miscarriage may be incomplete if:

• your bleeding is particularly heavy
• you have a fever
• an ultrasound reveals there’s still tissue in your uterus

If this is the case, your doctor may suggest a dilation and curettage (D and C), which is a surgical procedure done to remove remaining tissue. The procedure is done under general or regional anesthesia, and is considered safe. D and C doesn’t usually lead to long-term complications.

Threatened miscarriage

It’s important to report any bleeding or pain you experience in your pregnancy to your doctor. In some cases, you may have what’s called a threatened miscarriage, and there may be certain treatments that can help. These include:

• hormone supplements if the bleeding is caused by low progesterone
• a cerclage (stitch in the cervix) if the issue is with the cervix opening prematurely

Speak with your healthcare provider if you’re looking to get pregnant again after a miscarriage. While it may be safe to start trying after your first normal period, you may want to schedule a checkup depending on the cause or the number of miscarriages you’ve had.

The reason for loss isn’t always known, but around half of miscarriages are caused by issues with the baby’s chromosomes.

Other possible causes include:

• uterine issues
• hormonal imbalances
• other health conditions, such as diabetes, autoimmune disorders, or polycystic ovary syndrome

After a miscarriage, you may have hcG in your blood for one to two months, which could lead to a false positive pregnancy test. In most cases, your period will return within four to six weeks, though you may start ovulating almost immediately following a miscarriage.

Speak with your doctor about birth control options if you don’t wish to become pregnant after a miscarriage.

Will I miscarry again?

Having one miscarriage doesn’t necessarily increases your chances of having another. The risk remains around 20 percent.

Two or more miscarriages is referred to as recurrent pregnancy loss (RPL). The risk of miscarriage after two losses is 28 percent. After three consecutive losses, it increases to 43 percent.

Only 1 percent of people experience three or more miscarriages. About 65 percent of those with unexplained RPL go on to have successful pregnancies.

Activities like exercise, work, morning sickness, and sex don’t cause miscarriages. Even things like smoking or drinking alcohol or caffeine, which can lead to other complications, are also unlikely to lead to early pregnancy loss.

A miscarriage can be physically painful, and it may also cause a variety of emotions. While your body may recover in a few weeks, be sure to take time to process your feelings, grieve, and reach out for help when you need it.

Miscarriage, how to avoid - Planning and management of pregnancy in the gynecology of the Literary Fund polyclinic after a miscarriage

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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

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

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

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 initiated.

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.

Sign up for a consultation with an obstetrician-gynecologist by phone +7 (495) 150-60-01

Tyan Oksana Alexandrovna

Head of the department, obstetrician-gynecologist Doctor of the highest category Work experience: 26 years

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Obstetrician-gynecologist, doctor of ultrasound diagnostics Doctor of the highest category Experience: 35 years

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Save at all costs: reasons for abortion

January 17, 2017 Articles on gynecology

According to Wikipedia, 15-20% of clinically diagnosed pregnancies end in spontaneous abortion. These numbers are a lower estimate, as many miscarriages occur in the early stages, before the woman knows she is pregnant. After all, often the clinical signs of a miscarriage are mistaken for heavy periods or for their delay.

What are the reasons for termination of pregnancy at different terms? How to prepare for pregnancy after a bad experience that ended in a miscarriage? These questions were answered by an obstetrician-gynecologist of the highest category at Bullfinch Medical Center ALEXANDER GIL.

- Alexander Vadimovich, most miscarriages happen at the beginning of pregnancy, and many women are perplexed: why could this happen?

— The main cause of miscarriages up to 6 weeks is natural selection. There is a laying of pregnancy with congenital malformations of the embryo, which is no longer viable - thus, natural selection is carried out, in which we cannot interfere.

You will never know the exact cause of a miscarriage at this time, even if after abrasion (curettage of the uterine mucosa), the contents are sent for research. As a rule, the answer comes: “short-term pregnancy” and nothing more.

There is another reason for termination of pregnancy, especially if it is not the first one - Rh-conflict (when a woman has Rh-negative blood, and men - Rh-positive). But in our country, effective prevention of the Rh conflict is used, so that troubles can be avoided at the stage of pregnancy planning.

In the structure of early termination of pregnancy, no one excludes infections and problems associated with hormones. At a period of 6-8 weeks, promising pregnancies are often interrupted due to a lack of hormones. During normal pregnancy, a woman has a so-called corpus luteum in one of the ovaries, which produces endogenous progesterone.

Unfortunately, the functioning of the corpus luteum ends by about 7 weeks of pregnancy, and if initially there was not enough endogenous progesterone, the pregnancy stops developing: the fetal egg detaches and the so-called missed pregnancy occurs.

In some cases, with detachment of the fetal egg, pregnancy can be saved, the main thing is to contact a specialist in time. If, according to the results of ultrasound studies, the doctor sees that the embryo is still alive, pregnant women are prescribed exogenous progesterone in tablets or suppositories. This hormone also exists in the form of injections - it is used to saturate the body faster and prevent miscarriage.

- Agree, when a woman becomes pregnant, she cannot suspect that she does not have enough progesterone in her body. What should be her concern? What signs indicate this?

- Any discharge from scanty dark brown to more profuse bloody is a bad sign. You should not hesitate to contact a gynecologist.

In the event of spotting, an ultrasound examination is indicated, a blood test for progesterone.

I want to say that lack of progesterone can cause miscarriage up to 15 weeks. At 15-16 weeks, the placenta is finally formed, which will secrete (produce) this hormone.

— Alexander Vadimovich, what problems can arise with the placenta during pregnancy?

- In the early stages, the chorion (unformed placenta) can block the internal os, maybe its marginal location - this is a big risk of abortion. In this case, the woman is admitted to the hospital and observed for up to 16 weeks - by this time, the chorion, as a rule, rises. But there remains a percentage of pregnant women in whom the placenta overlaps the cervix of the uterus - this is called the "central location of the placenta." To maintain pregnancy, such women, as a rule, must be in the clinic and under observation all the time.

— What is the treatment for infections that appear during pregnancy?

- Infections can occur even in women who were carefully examined before pregnancy. Often this problem occurs due to spotting - this is a favorable environment for the development of infections.

Ectopia (erosion) of the cervix is ​​also an infection that is a clear threat to pregnancy. Therefore, it is so important to undergo a colposcopy before conception and be treated for ectopia, if it is detected.

Infection by the ascending route can penetrate in utero and adversely affect the health of the fetus. There is such a complication as intrauterine fetal pneumonia, which is treated very poorly and occupies a large percentage in the structure of infant mortality.

And we treat infections whenever possible in any way that is prescribed in the protocol. There is such a tactic, which is to take antibiotics. There is no need to be afraid of them, as the doctor will prescribe only medicines approved for pregnant women. Sometimes you have to use those drugs, the benefits of which are greater than the risk of adverse reactions.

— What threats can affect a mid-term pregnancy?

— Among the many causes that lead to spontaneous miscarriages is isthmic-cervical insufficiency. This is a condition in which the isthmus and cervix cannot cope with the increasing load (growing fetus, amniotic fluid), begin to open - and the baby is born prematurely.

There are indications for the prevention of this condition - the imposition of a circular submucosal suture on the cervix. The best time is 16-17 weeks. You can do this procedure after 20 weeks, but the effect will be less.

In the middle of pregnancy, a placental abruption can occur in a woman. In some cases, pregnancy can be saved with the help of drugs that affect blood clotting. But often doctors are forced to resort to a small caesarean section. As a rule, childbirth before 22 weeks ends in the death of the fetus, and here we are already talking about saving the life of the mother.

I encourage pregnant women to refrain from flying. In my medical practice, there have been several cases where placental abruption in patients occurred during a flight. Who will provide you with qualified assistance in this case? I advise you not to take risks.

In Belarus, as in other European countries, labor begins at 22 weeks, but it is considered premature. Doctors are doing everything possible to save a promising pregnancy by any means. The main thing is to always be under the supervision of a specialist and follow all his recommendations.

- Alexander Vadimovich, unauthorized termination of a desired pregnancy is always a great psychological trauma for a woman. No one wants to experience this again. What are the features of preparing for the next pregnancy after a miscarriage?

— Before thinking about a second pregnancy, it is advisable for women who experience mental anguish to undergo a course of psychotherapy. This is very important, because mental problems can be very serious, especially in women after unsuccessful in vitro fertilization (IVF).

The main rule: do not get pregnant after a miscarriage for 6 months. It is best to protect yourself at this time with oral contraceptives, which the doctor will prescribe. This is necessary in order to restore normal reproductive function.

A set of examinations for women who have had a miscarriage is ordered individually. But the general recommendations are:

1. Diagnosis of sexually transmitted infections: mycoplasmosis, ureaplasmosis, chlamydia, herpes simplex virus, human papillomavirus (HPV).

You should also be screened for infections that may have caused a miscarriage in a previous pregnancy.

2. Test for sex hormones - if prescribed by a doctor.
3. Thyroid hormones (TSH, T4 free, ATPO), ultrasound of the thyroid gland, consultation with an endocrinologist.
4. If necessary, consultation of a therapist and other specialists, a blood test for sugar, syphilis, HIV.
5. Ultrasound of the abdomen and kidneys. During pregnancy, many chronic diseases are exacerbated, incl. and kidney disease. You need to be treated before conception.
6. Colposcopy (examination of the cervix under a microscope).
7. Partner semen analysis.

An examination by a geneticist is indicated if, when planning a pregnancy, a woman is 36 years old, and a man is 45 years old and over. Also, this doctor should be visited by a couple who had two non-developing early pregnancies in a row.

Another tip from practice. Many women, having barely become pregnant, rush to confirm this on an ultrasound. Of course, there is no direct evidence that such research is harmful to the fetus, but there is also no evidence to the contrary that it is absolutely harmless. Since you so desire this pregnancy, it’s not worth the risk, and a competent doctor will definitely warn a woman against doing an early ultrasound without any special indications.

You can determine pregnancy and its prospects with the help of a blood test for hCG (human chorionic gonadotropin), or, more simply, the pregnancy hormone. It is absolutely harmless for pregnancy. It is advisable to donate blood at the beginning of the delay, a week later - again. If the increase in hCG is normal, then the pregnancy is promising, not ectopic - and there are no indications for ultrasound.

For the first time, a woman should come for ultrasound diagnostics at 11-12 weeks of pregnancy. Alexander V. Gil Alexander

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