Updated April 2014

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Miscarriage

Miscarriage is more common than you may realise. The majority of miscarriages happen before others, and sometimes even the mother herself, are aware of the pregnancy.

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A miscarriage is the loss of a baby from the date of a missed period up to 24 weeks of pregnancy. 

You may hear miscarriages described as either ‘early’ or ‘late’. An ‘early miscarriage’ may happen until 12 weeks of pregnancy. A ‘late miscarriage’ may occur between weeks 12 to 24 of pregnancy. A stillbirth is the death of a baby during pregnancy or labour after 24 weeks of pregnancy.

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How common are miscarriages?

Miscarriage is most likely to happen during the first 12 weeks of preganncy. Many of these 'early' losses are experienced by women who weren't even aware they were pregnant, and assume the bleeding is the result of a normal period. A 'late' miscarriage, which is much less common, may occur between weeks 13 to 24 of pregnancy. After 24 weeks, the delivery of a baby who has died in the womb is referred to as a stillbirth.

As most miscarriages happen in the early few weeks of pregnancy, many women will not yet have told their friends or family that they were pregnant. Unless someone close to you has had a miscarriage and told you about it, you may not have thought about the subject until you become pregnant yourself.

For many of these women a miscarriage may have occurred so early that they weren’t actually aware that they were pregnant. Read our Miscarriage statistics for more information, including the statistics related to age.

Find out more about the causes of a miscarriage.

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Symptoms of a miscarriage

Vaginal bleeding is the most common symptom of a miscarriage; it can vary from light spotting to a heavy bleed, heavier than a normal period. Some women are shocked by the volume of blood that they seem to lose.

Other signs are cramping or abdominal pain. Some women describe simply not feeling pregnant anymore. They may have lost the pregnancy symptoms such as nausea or breast tenderness that they had previously been feeling.

Some women have no signs at all that their baby has died. This can be particularly painful if the first they know of this is when they go for their first scan and are told that the baby is no longer alive. This is called a missed miscarriage.

Every woman’s experience of miscarriage is different, but may include the following:

  • pain (abdominal cramps, which may be mild or severe; a dull ache or sharp pain; backache)
  • bleeding (heavy loss, light spotting or brown discharge), although sometimes there is no bleeding.

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If you think you are having a miscarriage

Seek help as quickly as possible if you experience any of the symptoms of a miscarriage in your pregnancy. Make a note of when symptoms started as this may be helpful later.

Bleeding in pregnancy should always be investigated. If you are bleeding put on a clean sanitary pad – don’t use tampons - and monitor your bleeding.

If you are experiencing severe bleeding, such as soaking through a sanitary pad every hour or less, or are having severe abdominal pain, feeling dizzy or faint you should go to your local A&E department urgently. Also, if you are having abdominal pain on just one side, or feel pain in your shoulders you should also go to A&E. These can be signs of an ectopic pregnancy  where the baby is growing outside the womb.

If you have other symptoms such as lighter spotting, pink discharge or light bleeding, dull cramping in you stomach or back, your first choice may be to see your GP. Ask for an appointment for the same day and take a sanitary pad to show them the discharge and describe to them how you feel. Explain if you are no longer feeling your pregnancy symptoms or these have changed.

Your GP should discuss your symptoms and they may either send you to hospital or ask you to monitor minor symptoms and return at a set time.  

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What will happen at hospital?

If you’re less than 18 weeks’ pregnant, you will probably be referred to the early pregnancy unit at your local hospital. If your pregnancy is more advanced, you may be sent to the hospital’s maternity unit.

After giving your medical history and explaining your symptoms, you may be offered an ultrasound scan. This may be done through your tummy, or vaginally if the pregnancy is very early on. Both are completely safe.

Sometimes, a scan may not show what’s happening. This may be because it’s early on in your pregnancy, when it’s not always possible to detect a fetal heartbeat.

Sometimes you may be offered a blood test to detect levels of pregnancy hormones, which should indicate whether or not you’re still pregnant. If the results of the scan and blood test show that you are miscarrying, the doctors and nurses looking after you will explain what treatment you need might need. You may also be offered a blood test to check your blood group, because if you have a Rh (rhesus) negative blood group, you may be given an injection ‘anti-D’ to protect future pregnancies if you are 12 or more weeks pregnant or if you need surgery as a result of the miscarriage.

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Will I find out straight away whether I have miscarried?

Unfortunately, this can’t always happen. There are a number of reasons why you might not find out straight away if you are still pregnant.

There may be practical issues, such as the scan department being closed at the time of day that you are there. Or it may simply be too early in the pregnancy or in your condition to give you a definite answer. They may be able to see a pregnancy on scan but it might be too early to see a heartbeat for example.

They may advise you to return home and come back to the hospital in a week or two. They may then be able to repeat blood tests looking for an increase in the pregnancy hormones or to repeat the scan. Before you leave hospital do make sure you know exactly when and where you should return, and ask under what circumstances you should return early, such as if bleeding or pain increases.

Going home without knowing whether your pregnancy is continuing can be very difficult. You are likely to feel very anxious and distressed and will need good support from a friend, partner or family. If you haven’t told anyone about your pregnancy this may be a good time to confide in someone close who can support you and come back to hospital with you if that is what you would like. Tommy's PregnancyLine offers advice and support.

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What to be aware of if you have had a miscarriage

  • Take sufficient painkillers to ease the cramps – this is no time for heroics – and ask your doctor for something stronger if you’re suffering. You may also be prescribed antibiotics to reduce the risk of infection.
  • The bleeding may last for several weeks.
  • You’ll need plenty of extra-thick sanitary towels (if the bleeding is heavy, you may need to change them hourly or more frequently). Tampons are not suitable due to the risk of infection. When you leave hospital you will need someone to take you home and look after you.
  • Most doctors advise abstaining from sexual intercourse while you’re bleeding.
  • Swimming isn’t recommended.
  • Avoid washing with scented products as this may cause irritation.
  • After a late miscarriage or stillbirth, your body will react in the same way as any new mother’s: you may have after-pains as the uterus contracts back to its usual size. You may also have lochia (vaginal blood loss) and your breasts may produce milk. Ask your midwife or doctor if you need help to manage these symptoms.

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More about miscarriage in early pregnancy (early miscarriage)

Early miscarriage is by far the most common type of miscarriage. This is when a woman loses her pregnancy in the first three months. Many early miscarriages may go unnoticed if they happened happen before a woman has missed her period or had a positive pregnancy test.

Most miscarriages occur in the first three months and often occur as a ‘one-off’ event, so there is a good chance of having a successful pregnancy in the future. Click here to see the possible causes of early miscarriage.

Types of early miscarriage

  • Complete miscarriage: Once all the contents of the womb have come away, the miscarriage is complete. This is by far the most common type of early miscarriages.
  • Missed or delayed miscarriage: When the baby has died or stopped growing but a miscarriage hasn’t taken place. This can be particularly distressing as the woman may not have experienced any symptoms and may not realise anything is wrong until she goes for a routine scan.
  • Incomplete miscarriage: When the woman starts miscarrying but some of the pregnancy tissues remain in the womb. She may experience prolonged bleeding and may develop symptoms of an infection, which needs to be treated promptly.

Treatment of early miscarriage

After a ‘complete’ miscarriage (see above) you may be advised to go home to rest and recuperate. In all other instances, once miscarriage has been diagnosed, it’s important to have the correct treatment without delay. There are three possible options, and your doctor will advise you on which is one the best for you, depending on your symptoms.

1. Letting nature take its course (called expectant management)

This is most successful in early pregnancies and is effective in 50 per cent of cases of missed miscarriage. It can take some time before the bleeding starts. Most women experience the bleeding as a heavy period, which may last for three weeks or longer. It’s normal to have abdominal cramps, but if you experience severe pain or very heavy bleeding, seek medical help immediately as admission to hospital might be needed.

2. Taking medicine (called medical management)

This is used to treat a missed miscarriage or an incomplete miscarriage and involves either swallowing tablets and/or using vaginal pessaries (procedures vary between hospitals) to help the neck of the womb to open and to allow the pregnancy to pass. It usually takes a few hours and is accompanied by cramps and bleeding. The bleeding may continue for up to three weeks. This method works well in around 85 percent of cases. For most women, it starts the process off and they can then let nature take its course (see above). In a small number of women, medical management doesn’t succeed. In this case, surgery (see below) may be necessary.

3. Surgery to remove the pregnancy tissues (surgical management)

This is usually carried out under a general anaesthetic. It is usually a planned operation and involves the cervix being opened gently with a small tube and any remaining pregnancy tissue removed using a suction device. This is called ‘evacuation of retained products of conception’ or ERPC and has a 95 per cent success rate. Often hospitals will send a sample of pregnancy tissues to the lab to make sure that everything has been removed.

The risk of infection is similar for medical or surgical management

You may be advised to have surgery if you are bleeding heavily or the miscarriage has become infected

Further tests are not performed routinely unless you have had three miscarriages in a row, as most women will go onto have a straightforward pregnancy in future.

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More about miscarriage in late pregnancy (late miscarriage)

A late miscarriage is the loss of a pregnancy between 13 and 24 weeks. It is much less common than an early miscarriage.

Causes of late miscarriage

  • Structural: A cervix that is weak or dilates too soon (known as cervical weakness), can lead to late miscarriage. This can sometime occur after surgery on the cervix following an abnormal smear. Women who are known to be at risk will be offered a scan to measure the length of their cervix or may need a stitch in their cervix to help prevent this.
  • Infection Any severe infection a woman develops during pregnancy may result in miscarriage. This is relatively rare.
  • Food poisoning, such as listeria and salmonella; along with some infections of the blood, such as hepatitis, cytomegalovirus, human immunodeficiency virus (HIV), rubella and toxoplasmosis, can cause miscarriage or problems within the developing baby.
  • Experts are investigating whether vaginal infection could also be a cause.
  • Other rare structural problems that can inhibit the attachment of the placenta or baby’s growth and may lead to miscarriage are an abnormally shaped womb and large fibroids that grow in the womb. Pre-pregnancy surgery can sometimes solve these problems.

Treatment of late miscarriage

In late miscarriages, the baby will usually be passed naturally, or with the help of hormonal drugs in hospital.

Read more about what happens after a miscarriage here

 


 

You can find out more in our Questions about miscarriage page.

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Also in this section


Sources

National Institute for Health and Care Excellence, Ectopic pregnancy and miscarriage: diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage, clinical guideline CG154, London NICE, 2012. Also available at: http://publications.nice.org.uk/ectopic-pregnancy-and-miscarriage-cg154/recommendations (accessed 8 April 2014)

Stillbirth (Definition) Act 1992, Definition of stillborn child, Section 1(1), London The Stationery Office, 1992

Royal College of Obstetricians and Gynaecologists, Early miscarriage: information for you, London RCOG, 2008

Royal College of Obstetricians and Gynaecologists, Bleeding and Pain in early pregnancy: information for you, London RCOG, 2008

Royal College of Obstetricians and Gynaecologists, Recurrent and late miscarriage: tests and treatment of couples, information for you, London RCOG, 2012

 

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On this page


How common are miscarriages?

Symptoms of a miscarriage

If you are having a miscarriage

What will happen at hospital

Will I find out straight away?

What to be aware of if you have miscarried

More about early miscarriage

More about late miscarriage



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