Miscarriage

Having a miscarriage can be very upsetting. The pregnancy loss usually occurs before you are 20 weeks or roughly five months pregnant.

Not all miscarriages present the same way, however. Whether or not you have any symptoms generally depends on how pregnant you are and the timing of the diagnosis. You might have the typical symptoms of vaginal bleeding or uterine cramping. But it is also possible that you may not have any symptoms at all.

Most miscarriages happen during the first trimester before you are 13 weeks pregnant. Fortunately, your risk of miscarriage significantly decreases the farther along you are in pregnancy.

What Causes a Miscarriage?

If you are having a miscarriage you may be wondering if you did something that caused you to lose the pregnancy. This is very unlikely, especially if your miscarriage happened before 13 weeks.

In fact, about 50 percent of all early pregnancy losses are due to chromosomal abnormalities. However, some lifestyle choices can increase your risk of miscarriage, such as cigarette smoking and drug use. Other less common causes of miscarriage include:

• structural problems of the uterus or cervix
• infection
• maternal autoimmune disorders
• maternal thrombophilia

3 Things to Know About Miscarriages

Miscarriages Are Common

If you have recently had a miscarriage, you are not alone. Studies show that about 15 percent of all clinically diagnosed pregnancies end in miscarriage. That means that out of 100 women who just found out they are pregnant around 15 will have a miscarriage.

Unfortunately, your risk of miscarriage does increase with your age. Studies suggest that your age-based risk of miscarriage is as follows:

• 9-17 percent at ages 20-30 
• 20 percent at age 35
• 40 percent at age 40
• 80 percent at age 45

If your doctor hears a heartbeat at 12 weeks your risk of a miscarriage drops to under 5 percent and may even be as low as 1 percent by the time you reach 20 weeks.

Recurrent Miscarriages Are Not Common

Although first trimester miscarriages are common, having more than one miscarriage in a row is not. Simply put, you are much more likely to have a successful pregnancy after a miscarriage than you are to have a second miscarriage. The diagnosis of recurrent pregnancy loss is typically defined as three or more consecutive miscarriages, and studies suggest that happens only in 1 to 2 percent of pregnant women. But even if you have had more than three miscarriages in a row it is still more likely that your next pregnancy will continue to term.

Not All Bleeding in Early Pregnancy Is a Miscarriage

If you are less than five months pregnant and you are having some vaginal bleeding, don't panic. Not all bleeding in early pregnancy means you are having a miscarriage. 

• You may have some bleeding in early pregnancy from the normal process of the embryo attaching to the wall of your uterus. This is called implantation bleeding. It is usually light bleeding and may be associated with mild cramping.
• Sometimes this implantation bleeding can collect under the placenta and cause a collection or clot of blood. This can be seen on ultrasound and is called a subchorionic hemorrhage. This type of bleeding may be a little heavier than implantation bleeding and you may have some cramping. You may continue to bleed off and on for a few weeks. Usually, the collection of blood will be reabsorbed by your body and the bleeding will stop. 
• Did you recently have sex and now you are bleeding? If so, it is likely that you are just bleeding from your cervix. When you are pregnant the surface of your cervix changes in response to your changing hormone levels. This makes your cervix more likely to bleed when it is touched during sex. This type of bleeding is called post-coital bleeding. It is typically bright red and it may be quite heavy. It is not typically associated with uterine cramping.

• Sometimes light bleeding that you notice only when you wipe yourself after you pee may be a sign of a urinary tract infection. UTIs are very common in early pregnancy and often they don't present with the typical symptoms of frequent and painful urination.

It is important to tell your doctor about any vaginal bleeding that you have when you are pregnant. You may have light staining or spotting of dark red, pink, or bright red blood. If your bleeding is very heavy and associated with strong menstrual cramping it is more likely that you are having a miscarriage.Your doctor will likely do an exam and/or some testing to be sure that everything is OK with your pregnancy. 

Your doctor will also check your blood type. If you are Rh negative your doctor will talk to you about a special injection called RhoGAM. This injection will help prevent a pregnancy complication called hemolytic disease of the newborn.

If You Have Recently Had a Miscarriage

Talk With Your Doctor About Your Treatment Options

Depending on how far along in pregnancy you are and how much you are bleeding,  you may have some choices on how to manage your miscarriage.

However, if you are bleeding very heavily and you haven't passed all of the pregnancy tissue you will likely need an emergency D&C to clean out your uterus and stop the bleeding. If you are stable when you are diagnosed your doctor will likely discuss these three treatment options with you.

• expectant management -You may choose no intervention and opt to let your body pass the tissue when it is ready. This approach is generally most successful if you are less than eight weeks pregnant and not recommended if you are more than 13 weeks. 
• medical management- You may choose to take a medication called misoprostol that will cause your uterus to pass the tissue
• surgical management- You may choose to have the tissue removed by a procedure called a D&C. Or if the miscarriage is early enough your doctor may offer you an in-office aspiration of the tissue in your uterus.

Based on how far along in pregnancy you are and your overall clinical condition your doctor may suggest one treatment option over the others.

Remember to Grieve

This can't be overemphasized. Having a miscarriage is very upsetting, and it is very important that you give yourself time to grieve your loss. 

Losing a pregnancy is just like any other loss of a loved one. You will have the same emotional reactions, although you may pass through the stages of grieving a bit quicker. Processing your emotions and seeking psychological support can help prevent a significant depressive episode.

Once you have lost a pregnancy you may find that you are more anxious in your next pregnancy. You may even feel ambivalent about the pregnancy. If you are finding it hard to become emotionally attached to your pregnancy after a miscarriage it is important to discuss this with your doctor. 

Return of Your Period

It typically takes about four weeks, but it can take as long as six to eight weeks before you see your period after a miscarriage.This delay is because the pregnancy hormone (human chorionic gonadotropin or hCG) has to return to nonpregnant levels before ovulation can occur again. Your period will come roughly two weeks after you ovulate. 

Try Again

One of the first questions you might have after a miscarriage is, "When can I try again?"

This is a very common question. Some physicians will tell you that you need to wait until you have had 3 regular cycles before you can try again. This is probably not necessary. Although there is no good data to suggest the optimum time to try to get pregnant after a miscarriage, some recent evidence suggests that there is no reason to delay. That being said, most physicians agree you should wait one to two weeks before having vaginal intercourse after a miscarriage to reduce the risk of infection.

A Word From Verywell 

Having a miscarriage is very upsetting and it is very important to let yourself grieve your loss. Although having an early pregnancy loss is quite common, having multiple miscarriages is not common. You are much more likely to have a successful outcome in your next pregnancy after a miscarriage than another miscarriage. Discussing treatment options with your doctor and getting emotional support for your loss will help you live very well after a miscarriage.

Sources:

American College of Obstetrics & Gynecology. (2015). ACOG practice bulletin no. 150: Early pregnancy loss. Obstet Gynecol. 125(5):1258-67.

Michels TC, Tiu AY. Second trimester pregnancy loss. American Family Physician. 2007;76(9),1341-1346