What to know about miscarriages

At least 10 percent of all clinically recognized pregnancies will end in miscarriage, according to the American College of Obstetricians and Gynecologists (ACOG). A clinically recognized pregnancy is one that has been identified on an ultrasound scan or for which pregnancy tissue was identified after a pregnancy loss.

Miscarriage is often an emotional experience for those involved. And while many people have a difficult time discussing this sensitive topic, if you or someone you know has had a miscarriage, it’s healthy to be open about it if you’re comfortable doing so.

Here's what to know about common miscarriage symptoms and causes, plus what you can expect to happen afterwards.

What is a miscarriage?

In short, a miscarriage is a pregnancy that ends on its own, usually sometime in the first 20 weeks of gestation or 20 weeks from your last period. The risk decreases as pregnancy progresses. Just 1 percent of miscarriages occur after 20 weeks. (In the first trimester, the term miscarriage is often used interchangeably with the term early pregnancy loss.)

“Miscarriages are most common before a woman reaches 12 weeks—the earlier in your first trimester, the more common they are,” says Lauren Linden, a midwife in Ann Arbor, Michigan.

What causes miscarriage?

It can be hard to understand why pregnancy loss happens. There are numerous factors, but just about half of miscarriages occur because there is some sort of chromosomal abnormality, or problem with the DNA of the fetus.

One of the most common risk factors for pregnancy loss is advanced maternal age (when a person becomes pregnant at age 35 or older). In fact, the risk of pregnancy loss increases sharply with age. The frequency of clinically recognized early pregnancy loss for women aged 20 to 30 years is 9 to 17 percent, according to ACOG. This rate increases to 20 percent at age 35 and then to 40 percent at age 40. By age 45, the frequency is as high as 80 percent.

Other factors that can increase one’s risk of early pregnancy loss include:

• Previous miscarriage
• Lifestyle issues like smoking and drug use
• Exposure to radiation or toxic substances
• Trauma such as car accidents and major falls
• Problems with implantation of the fertilized egg
• Advanced paternal age, especially when a father is age 45 or older
• Immune system disorders such as lupus (an autoimmune condition when the body's immune system attacks its own cells)
• Chronic conditions like uncontrolled diabetes, or heart, kidney, or thyroid disease
• Malnutrition
• Abnormal uterine shape
• Blighted ovum, which occurs when a fertilized egg attaches to the uterine wall but the embryo does not grow
• Ectopic pregnancy, a pregnancy that implants outside the uterus

Often, people are concerned that they may miscarry because of something they do within the first few weeks of pregnancy. But many of the things they may be concerned about—like working, exercising, having sex, and previous birth control use—are unlikely to cause a miscarriage.

Drinking alcohol before you know you're pregnant or during the first trimester could increase the risk of miscarriage. It's recommended that pregnant people not drink alcohol at any point during pregnancy.

Signs and symptoms

Sometimes, you may have a miscarriage even before you know you're pregnant. Other times, there are no symptoms at all. This is called a silent or missed miscarriage.

When there are signs of miscarriage, they vary from person to person. The most common are:

• Bright or dark red bleeding
• Mild to severe back pain
• Intense contractions every 5 to 20 minutes
• Tissue with clots passing from the vagina
• No longer feeling like you’re pregnant

In general, if something feels off, you should see your healthcare provider (HCP), especially if you’re having any or all of these miscarriage symptoms.

What happens after a miscarriage?

Once you're in your HCP’s office, they will do a pelvic exam and ultrasound to determine whether the fetal heart is beating normally or if you’ve had a miscarriage. Your HCP may also perform a human chorionic gonadotropin blood test.

Human chorionic gonadotropin (hCG) is a hormone produced during pregnancy by the placenta, an organ that develops inside the uterus to support and nourish the fetus. If your hCG levels are doubling, the fetus is growing normally. If your hCG levels are falling, that may be a sign of miscarriage.

Miscarriages that occur earlier in pregnancy may not require surgery or medical procedures, since the tissue may pass through your body naturally. During this time, HCPs commonly administer misoprostol, a medication that can help this process along. But if your HCP suspects the miscarriage was incomplete—that any fetal tissue remains in your body—it may need to be removed, because it can lead to infection. Treatment may also be needed if there’s heavy bleeding.

The most common surgical procedure for this is called a dilation and curettage (D&C). In this hospital procedure, the cervix is dilated, or opened, so any remaining pregnancy tissue can be removed by a suction device or curette, a small instrument used to scrape the tissue from the uterine wall. Another procedure is called vacuum aspiration, where a thin tube connected to a suction device is placed inside the uterus to remove remaining tissue.

Can miscarriages be prevented?

Since most miscarriages happen because of chromosomal issues, many of them are unavoidable. But if you’re trying to get pregnant—or even if you’re not—it’s a good idea to practice healthy habits to keep your body in good shape and reduce your risk. Some simple guidelines include the following:

• Get regular exercise as you are able.
• Eat a healthful, well-balanced diet rich in fruits, vegetables, lean protein, and whole grains.
• Manage your stress levels.
• Avoid smoking.
• Take a daily folic acid supplement.
• Maintain a healthy weight.

If you’re taking any type of prescription medication, talk to your HCP about whether it's safe to continue while you’re trying to conceive, says Linden.

Miscarriages and future pregnancies

One misconception is that once you’ve had a miscarriage, you won’t be able to get pregnant again. The majority of the time, this is not the case. In fact, 87 percent of people who miscarry go on to have regular pregnancies and births down the road.

It’s always best to speak with your HCP if you’ve had a miscarriage and you’re ready to start trying to become pregnant again.

"There is not a proven recommendation for the correct time to ‘wait,’” says Linden. "However, I do recommend waiting at least one menstrual cycle or the appropriate time that is needed to grieve the loss."

Your HCP may suggest waiting up to three months before trying, or that you receive fertility treatment. If you’ve experienced two miscarriages in a row, your HCP may advise taking a break from trying to conceive until they do a medical analysis to determine the cause. If you have questions about fertility testing, fertility treatment, and insurance coverage, ask your HCP.

If you are feeling grief or blaming yourself after a miscarriage, take time to process the loss and to heal both physically and mentally. Talk to your HCP about support groups that will allow you to discuss your feelings in an open and honest way.