What is a Miscarriage?
A miscarriage occurs when an expectant mother loses the baby early in the pregnancy, usually before Week 20. Around 26% of all pregnancies result in a miscarriage, which means the fetus stops developing and passes naturally. Approximately 80% such instances are more likely to occur in the first trimester of pregnancy.
A miscarriage can happen in several different ways, depending on the symptoms and stages of pregnancy.
- Threatened Miscarriage: There’s some bleeding, but the cervix is still closed. The pregnancy might still continue with rest and monitoring.
- Inevitable Miscarriage: Bleeding and cramping have started, and the cervix is opening. Unfortunately, the miscarriage can’t be stopped.
- Incomplete Miscarriage: Some pregnancy tissue has passed, but not all of it, so medical help is needed to remove the rest.
- Complete Miscarriage: All pregnancy tissue has passed, and the uterus is empty. Bleeding stops, and recovery begins.
- Missed Miscarriage: The baby has stopped growing, but the body hasn’t recognised it yet—there are no symptoms, and it’s often found during a scan.
- Septic Miscarriage: An infection develops in the uterus, which can be serious and needs urgent treatment.
Studies show that the risk of miscarriage goes down a lot after the first trimester. Here’s a rough idea of the chances:
- Weeks 1-4: Many miscarriages occur before a pregnancy is even detected, often mistaken for a late period.
- Weeks 5-6: The risk is around 20-25%, as the embryo begins developing major structures.
- Weeks 7-9: Once a heartbeat is detected, the risk drops to about 5-10%.
- Weeks 10-12: The risk continues to decrease, averaging 3-5%.
- Weeks 13-20: By the second trimester, the risk is less than 1-2%, though pregnancy loss at this stage is classified as a late miscarriage.
Most miscarriages happen in the first 12 weeks, often due to chromosomal abnormalities. After the first trimester, the chances of miscarriage drop significantly.
Miscarriage Symptoms
During pregnancy, it’s important to be alert regarding certain signs of a miscarriage. If you observe these miscarriage symptoms, it is best to visit your medical practitioner right away:
- Bleeding that starts off light and gradually gets heavier
- Extreme cramps and belly aches
- Fatigue and weakness
- Extreme back pain
- Fever along with other miscarriage symptoms
- Sudden weight loss
- Chills
- Whitish pink mucus-like vaginal discharge
- Tissue resembling blood clots passing through the vagina
- Contractions
You may also experience mild symptoms like spotting and a slight fever. Your doctor will examine you and guide you on the next course of action.
Miscarriages can happen for many reasons, and in most cases, there’s nothing you could have done to prevent it:
- Chromosome Problems: The most common cause of miscarriage is genetic abnormalities in the baby. If the embryo has too many or too few chromosomes, it may not develop properly, leading to an early pregnancy loss.
- Maternal Health Conditions: Certain medical conditions can make miscarriage more likely. Uncontrolled diabetes, thyroid disorders, high blood pressure, endometriosis, Pelvic Inflammatory Disease (PID), and autoimmune diseases can all affect pregnancy. Proper management of these conditions before and during pregnancy can sometimes lower the risk.
- Hormonal Imbalances: Hormones like progesterone help maintain a pregnancy. If levels are too low, the uterus may not be able to support the growing embryo, increasing the risk of miscarriage. Some women may need hormone therapy to help sustain a pregnancy.
- Uterine Abnormalities and Weak Cervix: Structural issues like uterine fibroids, scarring, or a septate uterus (where a band of tissue divides the uterus) can interfere with implantation and growth. A weak or incompetent cervix may also open too early, leading to pregnancy loss. Blocked fallopian tubes can prevent proper embryo implantation, while polyps may interfere with foetal growth, and adenomyosis—where the uterine lining grows into the muscle—can affect implantation.
- Lifestyle and Environmental Factors: Smoking, excessive alcohol consumption, drug use, and exposure to harmful chemicals or toxins can impact foetal development and increase miscarriage risk. Maintaining a healthy lifestyle before and during pregnancy can improve overall outcomes.
- Maternal Age: The risk of miscarriage rises with age, particularly after 35. Older eggs are more likely to have chromosome abnormalities, making it harder for a pregnancy to progress.
Diagnosing a Miscarriage
Doctors use several methods to confirm a miscarriage and rule out other conditions:
- Ultrasound Scan: The most common test, usually done trans-vaginally for accuracy. It checks for a foetal heartbeat and monitors pregnancy development. If no heartbeat is found, follow-up scans may be needed to confirm.
- Blood Tests: These measure hCG (pregnancy hormone) levels. If hCG is dropping instead of rising, it suggests a miscarriage. Tests are often repeated after 48 hours to track changes.
- Pelvic Exam: A doctor may check if the cervix is opening, which could indicate that a miscarriage is happening.
- Tissue Analysis: If tissue is passed, lab tests can confirm pregnancy loss and rule out other causes of bleeding.
- Genetic Testing: If miscarriages happen repeatedly, chromosomal testing may help identify underlying genetic causes.
The right treatment for a miscarriage depends on individual circumstances, how far along the pregnancy was, and whether there are complications. Here are the main options:
Expectant Management (Natural Process)
In some cases, the body will naturally expel the pregnancy tissue without medical intervention. This is often recommended for early miscarriages when there are no signs of infection or complications. The process can take days to weeks and may involve cramping, bleeding, and the passing of tissue. Regular follow-ups may be needed to ensure the miscarriage is complete.
Non-Surgical Management (Medication-Assisted)
If the miscarriage doesn’t progress on its own or if waiting isn’t preferred, medication can help speed up the process. A doctor may prescribe misoprostol, which causes the uterus to contract and pass the pregnancy tissue. This option is usually effective within 24-48 hours and may involve heavy bleeding and cramping, similar to a heavy period. Pain relief and follow-up scans are often recommended to ensure completion.
Surgical Management (Procedure-Based)
For those who experience heavy bleeding, incomplete miscarriage, or prefer a quicker resolution, a minor surgical procedure called dilation and curettage (D&C) may be performed. This procedure removes any remaining tissue from the uterus, preventing infection and complications. It is usually done under anesthesia and has a quick recovery time, though mild cramping and spotting may occur afterwards.
While some miscarriages happen due to genetic factors beyond control, certain lifestyle choices can help support a healthy pregnancy.
Healthy Lifestyle Choices
Taking care of your body before and during pregnancy can improve overall health and create a better environment for the baby to grow.
- Eat Well: A balanced diet with plenty of fruits, vegetables, whole grains, and lean proteins supports overall health.
- Take Folic Acid: Starting 1-2 months before conception, start taking folic acid, which helps prevent birth defects and supports foetal growth.
- Maintain a Healthy Weight: Being underweight or overweight can increase risks, so aim for a balanced BMI (19-25).
Avoiding Harmful Substances
Certain substances can increase the risk of pregnancy complications:
- No Smoking or Alcohol: Both increase miscarriage risks—even secondhand smoke can be harmful.
- Limit Caffeine & Avoid Drugs: Keep caffeine under 200 mg per day (1-2 cups of coffee) and avoid illegal substances.
Physical Health & Safety
Staying active and preventing infections can promote a healthier pregnancy and lower risks.
- Exercise Regularly: Staying active supports pregnancy, but consult a doctor before starting new workouts.
- Prevent Infections: Wash hands frequently, stay up to date on vaccines, and avoid high-risk foods.
Medical & Environmental Factors
Managing health conditions and avoiding harmful environmental exposures can help protect both you and your baby.
- Manage Health Conditions: Conditions like diabetes and high blood pressure need proper care to reduce risks.
- Attend Antenatal Check-Ups: Regular monitoring helps detect potential problems early.
- Avoid Environmental Toxins: Stay away from radiation, heavy metals, and harmful chemicals.
These steps create a healthier pregnancy environment, but it’s important to remember that not all miscarriages can be prevented.
The terms miscarriage and stillbirth both describe pregnancy loss but differ primarily in timing, causes, and medical implications.
| Aspect | Miscarriage | Stillbirth |
| Timing | Before 20 weeks of pregnancy. | At or after 20 weeks. |
| Causes | Mostly due to genetic issues; maternal health conditions may play a role. | Often caused by placental problems, infections, or umbilical cord issues. |
| Symptoms | Bleeding, cramping, loss of pregnancy symptoms, passing tissue. | Reduced foetal movement, severe pain, bleeding, sudden symptom changes. |
| Emotional Impact | Very difficult but happens earlier in pregnancy. | Emotionally devastating, as it involves delivering the baby. |
| Physical Recovery | Usually quicker, with natural passing or medical help. | Requires labour induction or C-section, leading to a longer recovery. |
The right time to try again varies based on physical recovery, emotional readiness, and medical advice.
- Medical Recommendations: Many doctors suggest waiting around three months to allow the uterus to heal and menstrual cycles to normalise.
- WHO Guidelines: The World Health Organization advises waiting six months to reduce the risk of complications in future pregnancies.
- Trying Sooner: Some experts say conception is possible as soon as the next menstrual cycle, as ovulation can occur within two weeks after a miscarriage.
- Emotional Readiness: Taking time to grieve and heal emotionally is just as important as physical recovery. Try again when both partners feel ready.
- hCG Monitoring: Some doctors recommend waiting until hCG levels return to zero (about six weeks) to avoid confusion in pregnancy tests.
- Consult a Doctor: If you’ve had multiple miscarriages or complications, a fertility doctor can guide you on the safest time to conceive again.
Ultimately, the best time is when you feel physically and emotionally prepared.
The Takeaway
No medical evidence exists to prove that occurrences of miscarriage lead to female infertility. However, research indicates that those accessing reproductive assistance to get pregnant may be at a greater risk of having a miscarriage.
Hence, it is important to ensure that you consult an experienced fertility specialist when pursuing reproduction assistance as part of your fertility goals.
To seek the best treatment for infertility concerns, visit your nearest Birla Fertility and IVF centre or book an appointment with Dr Deepika Mishra.
FAQs
Is a miscarriage the same as losing a baby?
A miscarriage happens when the foetus is still in the womb and stops developing. It usually happens before 20 weeks of pregnancy, when the foetus is not a fully formed baby. The foetus, along with the placenta, passes in the form of tissue and bleeding. After week 10, the growth of the foetus accelerates.
What exactly happens in a miscarriage?
When a miscarriage occurs, the foetus gets expelled from the uterus on its own.
Typical signs of a miscarriage include heavy bleeding, abdominal cramps, and tissue resembling blood clots in the vagina. However, sometimes symptoms of miscarriage are subtle with spotting and light cramps.
How painful is a miscarriage?
The levels of pain during miscarriage can vary. Some women experience extreme abdominal pain, while for others, it is painless. Some may also experience severe lower back aches and extreme fatigue.
How do miscarriages start?
The genesis of the miscarriage may occur as early as the fertilization stage when either the egg or the sperm has fewer chromosomes. Hence, when they are joined together, the embryo develops with chromosomal abnormalities. This causes the fetus to stop growing.
Other triggers include exposure to harmful radiation, drugs, smoking, other external factors, or pre-existing diseases and medical conditions.
