Miscarriage

If you or someone you know has recently suffered a miscarriage or you simply want to know more, you can find information in this section. If you would like further support or guidance, please visit our In Memory section.

So what is a miscarriage?

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.

There is a difference in medical terms between a miscarriage and a stillbirth. A stillbirth is the death of a baby during pregnancy or labour after 24 weeks of pregnancy.

How common are miscarriages?

For many people, their first emotion is shock when either they or someone close to them has a miscarriage, as it is not something you hear much about. 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. Some women don’t worry about it and think it is either rare now or happens to other people, whilst other women think about little else for the first few weeks of pregnancy.

Whatever your feelings about miscarriage, the facts are that sadly 1 in 4 pregnant women lose their babies. For many of these women a miscarriage may have occurred so early that they weren’t actually aware that they were pregnant. You can read more about miscarriage statistics and the statistics related to age.

What are the 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.

You should be aware though that women can have a spell of bleeding during the early weeks of pregnancy and go on to have a normal pregnancy.

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.

Where should you go if you think you may be having a miscarriage?

If you experience any of the symptoms of a miscarriage in your pregnancy you should seek help. It is generally better to ask for help than to wait and see at home. 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. If your GP surgery is closed or you are unable to get an appointment you could ring NHS Direct on 0845 46 47, who will advise you where you should seek help.

What will happen if I go to hospital?

If you go to hospital you may initially be assessed by a skilled nurse, who will assess if you need to be seen urgently. If your hospital has one, and it is open, you may be directed to go to an Early Pregnancy Unit or Emergency Gynaecological clinic. If you are beyond approx 16 weeks you may be asked to go to the labour ward or the hospital’s antenatal assessment unit.

You will probably be asked a number of questions about your pregnancy and the symptoms you are suffering. It may be helpful to have written down what time any bleeding or other symptoms started to help you remember. They will probably ask you to give them a sample of your urine and your blood pressure and temperature will probably also be checked. Depending on your symptoms and the time of day you may be offered a scan at this point. They may also take blood tests.

Your notes will probably now say 'Threatened miscarriage'. This can seem very scary but the good news is that it doesn’t mean you are having, or that you will definitely have, a miscarriage. It is simply the medical term that is used if you have had symptoms of a miscarriage such as bleeding. Many women who have a threatened miscarriage still go on to have a healthy rest of their pregnancy.

Will I get the results straight away?

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 and this, of course, can be really distressing.

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 day 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. Ask if there are any activities you shouldn’t be doing – for example heavy lifting, sex, work or exercise. Also, ask under what circumstances you should return early, such as if bleeding or pain increases.

Going home whilst not knowing whether your pregnancy is continuing can be very difficult. Many women say they feel in a kind of limbo. 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.

If I have a miscarriage confirmed, what will happen next?

If during your initial visit to hospital, or on subsequent visits, it is found that you are having a miscarriage, there are a number of things you may be offered.

Once a miscarriage has been confirmed a scan can show if the miscarriage was complete. Meaning that the bleeding that you experienced resulted in the complete loss of the pregnancy. Otherwise the scan may show that you have yet to lose any or all of the pregnancy – although the baby has died. If this is the case you may be offered expectant management, medical treatment or surgical treatment.

Expectant management, sometime called conservative management, is basically the wait and see approach or sometimes described as letting nature take its course. This method works for around 50% of women. You will be able to go home and await the miscarriage. Most units will provide you with leaflets letting you know what to expect during this time. They may well also give you pain killers to take home with you. Some women prefer to be treated conservatively as they would like to avoid surgery and an anaesthetic. It may take a while before bleeding start, if it hasn’t already, and it may take around 3 weeks for all the bleeding to stop. For many women this bleeding is heavier than a normal period and some women experience cramping pains with the bleeding. If during this time the bleeding becomes particularly heavy, the pain is severe or the bleeding does not start you may be advised to have the medical or surgical treatment.

Medical treatment is where you are given either tablets to take or pessaries to insert into your vagina which allow the cervix (the neck of the womb) to open slightly, allowing the pregnancy to pass. You will usually be able to return home after a few hours but will have to go back to hospital if the bleeding or pain is severe. You can take pain relieving drugs to help with cramping and abdominal pain. You will pass blood and possibly clots which are usually heavier than a normal period. You may continue to bleed for around 3 weeks. Medical treatment is successful in around 85% of all cases but you may find that it is not an option offered at all hospitals.

The surgical treatment is successful in around 95% of cases. It is called an evacuation of retained products of conception (ERPC) or evacuation of the uterus. It is similar to a dilatation and curettage (D&C) operation. It is usually carried out as a planned operation in the few days after a miscarriage is confirmed. It is often done under a general anaesthetic but can occasionally be carried out under a local anaesthetic. You are sometimes given tablets or a pessary before the operation to soften and slightly open the cervix. During the operation the doctor gently opens the cervix and a suction device is used to remove the pregnancy.

As with all treatment there are some risks of surgery that will be explained to you before you give your consent for the operation. These include the risk of infection, heavy bleeding, needing to repeat the operation if not all the tissues are removed at the first operation, and less commonly a tear in the wall of the womb that needs repairing.

If the expectant or medical treatments have not worked, or your bleeding or pain is severe, there is infection or other complications of the miscarriage you may be advised to have the surgical treatment.

What happens during recovery?

Before you leave the hospital ask your doctors how long you should take off work and ask for a certificate if you need one for your employer. Different women will feel differently about how long they need to recover physically and emotionally. The unit that you are seen at will probably give you some leaflets about the experience of having a miscarriage and they may have information about local support groups.

Recovering emotionally from a miscarriage can be very difficult. From the moment you found out you were pregnant you were likely to be making plans for the future and imagining how you would be as a mother or father. You may have thought about the sex of the baby and possible names, you may have thought about moving home or planning nurseries and even childcare. It can be a huge shock to lose the baby and you may feel very alone and even disappointed by your body. Women often experience the same cycle of emotions as anyone who has lost a close relative or friend; denial, anger, guilt, feelings of emptiness and longing.

Talk to the people who support you best. Be prepared to give each other space and time to grieve and don’t expect each other to 'move on' or 'get over it' at the same time. If, after some time, you feel you are not coping with your feelings then do seek help. You may need more support such as professional counselling. See your GP if you need more help.

Some families choose to have a memorial service or write in a book of remembrance at the hospital. You can ask to see the hospital chaplain for more information about this. If you suffered a late miscarriage you may be able to see and hold your tiny baby – ask the hospital staff if this is possible. Some women have found it helpful to write letters to the baby or to themselves really writing out how they feel.

Find out more about the grieving process, and ways to remember your baby, in our When a Baby Dies section.

After a miscarriage

You may want to know more about why the miscarriage happened and the likelihood of it happening again. Unfortunately, in the vast majority of early miscarriages a cause is never found. Tests may be carried out on the tissues that are removed during a surgical operation to determine whether the miscarriage was due to an ectopic pregnancy or inside the womb or a molar pregnancy.

If you suffered a late miscarriage, it is more likely that a cause was known. For example, if your water’s broke early, you experienced a blood clotting disorder, problems with your placenta or infection. Or, it may be that your cervix opened early causing you to have a premature birth.

If this is a recurrent miscarriage, meaning that you have had more than 2 miscarriages in a row, then further tests will be arranged to try to find a reason for these miscarriages. If you have had recurrent miscarriages or a late miscarriage it is particularly important that a follow up appointment be arranged with a consultant obstetrician who specialises in these types of problems. If you are still in hospital, ask who would be the best consultant for you to see and arrange an appointment for whenever you feel ready to discuss these issues.

If you have left the hospital you may well be sent an appointment in the post. If you do not receive an appointment or would like to be seen by a team from a different hospital then you may need to do some chasing of your own. You could visit your GP and ask that a specialist referral is made on your behalf, ask the GP for the name of a consultant that specialises in the problems that you have experienced. The GP may need time to research this and let you know. The other option is to write or telephone the hospital directly. Try contacting the managers of the Women’s Health Department at your hospital, explain what happened to you and ask who you should see and how to get a referral to them.

A specialist should be able to discuss with you exactly what they thought may have happened and possible reasons. They can also advise you about how soon you could consider trying for another baby and also discuss with you the special support that you would receive in any future pregnancy. They may give you phone numbers to ring and fast track you to see them early in a future pregnancy without having to be referred.

In your next pregnancy you should be prepared for more antenatal check ups and scans if this is appropriate for you. Many units will offer reassurance scans to any woman who has had 2 or more miscarriages, ectopic or molar pregnancies or a stillbirth. During your pregnancy make sure you have been given details of any circumstances when you should return to hospital and are aware of any activities that you should not take part in during the pregnancy such as sex, exercise, lifting etc.

Trying for another baby

You will probably have your next period in 4-6 weeks following the miscarriage and you will be fertile and ovulating approximately 2 weeks before this date. Do use contraception if you do not want to become pregnant. You may be advised not to have sex until the bleeding has stopped and many are advised to wait until they have had one normal period before starting to try again. That said, if you were to become pregnant earlier it is very unlikely to cause a problem to the baby. Speak to your doctor about trying again and ensure that you and your partner both feel ready.

What causes a miscarriage?

There is still so much that isn’t known about miscarriage and there is still no treatment to stop an early miscarriage.

Genetic

The most common cause is a problem with the chromosomes. At the point of conception the baby receives these tiny thread-like structures from the mother and father. Sometimes, however, something can go wrong and the baby can receive either too many or not enough of these chromosomes and the baby cannot develop properly.

Hormonal

Some hormonal imbalances can lead to a number of conditions which make it difficult to conceive or carry a baby to full term.

Hormone-related conditions may also result in miscarriage. Conditions include polycystic ovaries (PCOS) or multiple cysts on the ovaries, often indicated by high levels of LH (luteinising hormone) and testosterone in the body, and the premature menopause, often the result of low levels of FSH (follicle stimulating hormone). Consult your GP about the various types of hormone imbalance and the treatments available.

Structural

There are some structural reasons why some women miscarry. If a woman has a weak cervix which dilates too soon this can lead to a late miscarriage. If a woman is known to be at risk from this condition then a cervical stitch may help to prevent early dilation.

If a woman has a uterus that has developed differently, for example into a divided uterus, the baby cannot grow healthily and this can often lead to an early miscarriage.

The presence of large fibroids in the uterus can also restrict space for the baby to develop fully, again leading to miscarriage. Surgery prior to pregnancy may help in these situations but is not always necessary depending on the size and location of the fibroids.

Blood clotting disorders

Some blood clotting disorders like Systemic Lupus Erythematosus (SLE) and Antiphospholipid Syndrome (APS) are known to cause recurrent miscarriage. APS and SLE are rare disorders of the immune system and interfere with the body's normal blood clotting. They affect the flow of blood to the placenta and may cause clots reducing the function of the placenta. This causes the baby to be deprived of essential oxygen and nutrients, which in turn may lead to miscarriage. These disorders might be effectively treated with specific drug treatments under medical supervision.

Infections

A number of infections can have serious consequences for the unborn child. Even if the baby is not miscarried, some infections can cause damage to the baby in the womb.

The role of vaginal infection as a cause of miscarriage is being investigated. It is thought that some vaginal infections may play a role in causing some late miscarriages.

Some infections of the blood such as cytomegalovirus, rubella, and toxoplasmosis can lead to miscarriage. If the baby is not miscarried as a result of these infections, they can cause some birth defects.

Food poisoning, from listeria bacteria, can also lead to miscarriage. Again, if the baby is not miscarried some of these infections can cause some birth defects.

Treatment of infections or diseases prior to pregnancy, and prevention of infection during pregnancy, is important. Limited treatments for some existing infections are available during pregnancy; however, some of these treatments can cause damage to the unborn baby. Undertaking any treatment should be fully thought through, as well as carefully approved and monitored by health professionals.

Risk factors

There are also other risk factors that can increase the risk of, but not necessarily always cause, a miscarriage. This includes the age of the mother, miscarriage rates increase with the age of the mother. Other factors include obesity, smoking during pregnancy, drug misuse during pregnancy (particularly cocaine), drinking more than 200mg of caffeine, and drinking more than two units of alcohol a week.

A personal experience of a miscarriage

After seven years of trying to have a baby, Emma finally received the joyous news that she was pregnant. However, her bliss was short-lived when at 5 weeks pregnant she miscarried. Tragically, history repeated itself three months later, when she miscarried again at 7 weeks.

Emma was already on her hospital's waiting list for medical help in conceiving. In a routine procedure, a nurse ran a blood test, revealing unusual antibodies which could have caused her miscarriages. Under the guidance of her doctors she began taking simple drugs such as aspirin to combat this.

When Emma got the long-awaited call from her hospital to say she was top of the waiting list for medical help in conceiving, she was over the moon. She could start the treatment after her next period.

However when that period never came Emma wishfully took a pregnancy test. It came back positive! They were thrilled. Although Emma didn’t have a straight forward pregnancy and had to change her plans of a homebirth after developing pre-eclampsia, after over seven years of trying for a baby, Emma's wish was finally granted in August 2006 when Ilana Mai was born at 38 weeks.

Emma has since given birth a second time, to a beautiful baby boy, Lucas.

For more personal stories, and for support after suffering a miscarriage, please visit our When a Baby Dies section.

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