What is it:

A miscarriage is an unexpected interruption in pregnancy prior to 20 weeks. It generally occurs due to fetal malformation, but it can also happen because of a viral or bacterial infection.

Symptoms of a miscarriage include intense abdominal pain, vaginal discharge and vaginal bleeding. It is most common in the first 12 weeks of pregnancy, and many times, women may not even notice that a miscarriage has occurred. An unnoticed miscarriage is more likely to happen in the first 6 weeks of pregnancy, as it may be confused for a period.

Treatment for a miscarriage should be initiated as soon as possible. You should proceed to the emergency room if you notice any symptoms so that doctors can confirm a diagnosis and prevent complications (like sepsis due to retained products of conception).

Common symptoms

The main symptoms of a miscarriage are:

Vaginal bleeding
Strong abdominal pain, like an intense period cramp, that may radiate to the back
Fever or chills
Vaginal discharge with a foul odor
Passing of blood clots or tissue through the vagina
Lack of or decrease in signs that are common with pregnancy, like breast sensitivity or nausea
Lack of fetal movements for over 5 hours

Some women may also experience palpitations or drops in blood pressure. Read more about miscarriage symptoms.

It is important to seek medical attention or proceed to the closest emergency room if you experience any of these symptoms, so that a miscarriage can be diagnosed and treatment can be started.

Possible causes

The main causes of a miscarriage are:

Fetal malformation
Hormonal changes, like a lack of progesterone
Uterine problems, like a bicornuate uterus, a septate uterus, an arcuate uterus, or an endometrial deformity
Cervical problems, like cervical incompetence
Polycystic ovarian syndrome
Thyroid problems, like hypothyroidism or hyperthyroidism
Viral or bacterial infections, like gonorrhea, chlamydia, syphilis, micoplasma or toxoplasmosis
Uncontrolled diabeted
Trombophilia
Celiac disease
Autoimmune disease, like antibody antiphospholipid syndrome
A history of 2 or more miscarriages
Pregnancy after 35 years of age
Conception within 3 to 6 months of your last delivery
Use of an IUD
Excessive intake of alcoholic or caffeinated drinks
Drug abuse
Tabacco smoke exposure
Being underweight or obese
Invasive prenatal exams, like an amniocentesis or chorionic villus sampling

Taking medication or teas without your doctor’s knowledge can also lead to a miscarriage.

What to do if you suspect a miscarriage

Women who experience symptoms like intense abdominal pain and vaginal bleeding, especially after recent sexual encounters, should see their doctor to order an ultrasound to see if the baby if well and the placenta is well-positioned.

The doctor may advise the woman to rest and avoid intimate contact for at least 15 days. The doctor may also prescribe analgesics or antispasmodics to relax the uterus and prevent contractions that may lead to a miscarriage.

Confirming a diagnosis

The diagnosis for a miscarriage is confirmed by a doctor following an evaluation of the symptoms, a pelvic exam, a blood test (to check for beta-HCG, hemoglobin and hematocrit levels) and a pelvic or transvaginal ultrasound. The results of all of these exams will allow the doctor to come to a conclusion and diagnose the type of miscarriage.

Doctors may also order blood type and screen tests for women who do not know they blood type, especially if a blood transfusion is necessary, or if an anti-D immunoglobulin needs to be administered.

Other exams that the doctor may order to rule out causes of the miscarriages include viral culture swabs (to check for gonorrhea or chlamydia, for example), a urine test, and a culture of the vaginal discharge or eliminated vaginal tissue.

Types of miscarriage

A miscarriage can be classified by types in accordance with cervical characteristics and expulsion of uterine content. It can be complete, incomplete or missed.

The main types of miscarriage are:

Threatened abortion: This occurs when a woman presents with vaginal bleeding without cervical dilation. Generally, with this type, the pregnancy continues without any major risks.
Complete miscarriage: This occurs when all uterine content is totally eliminated through the vagina without any surgical intervention. It is most common the first 12 weeks of pregnancy.
Incomplete miscarriage: This occurs when only some of the uterine content is eliminated. Some products of the fetus, placenta and/or membranes may remain inside the uterus.
Missed miscarriage: This occurs when the fetus dies and the woman does not present with any symptoms or uterine activity to expel the fetal tissue. The fetus can remain in the uterus for 4 weeks or more.
Inevitable miscarriage: This occurs when the cervix has dilated, but the products of conception have not been eliminated.

There is also a septic miscarriage, which occurs following a uterine infection.

Treatment options

Treatment for a miscarriage should be guided by a gynecologist/obstetrician and it will depend on the type of miscarriage experienced. With an incomplete miscarriage, the doctor may prescribe medications to stimulate the total elimination of fetal tissue. The doctor may also opt to perform a procedure like a manual aspiration or dilation and curettage (D&C) to remove any residual fetal tissue and cleanse the uterus to prevent infections.

When there are signs of uterine infection, like a foul odor, vaginal discharge, intense abdominal pain, increased heart rate and fever, the octor may prescribe IV or injectable antibiotics and a uterine scraping. In serious cases, uterine removal may be necessary.

Getting pregnant again

Following a miscarriage, women should be followed-up psychologically and be surrounded by family and friends to recover from the emotional trauma caused by the loss of a baby.

Women can try to get pregnant again 3 months after the miscarriage. They should wait for their period to return and go through at least 2 normal cycles before trying again. Otherwise, they can wait until they feel ready to become pregnant once again.