A miscarriage is the loss of a pregnancy during the first 20 weeks. It is most likely in the first trimester (the first 3 months) of a pregnancy.
The loss of a baby after 20 weeks is known as a stillbirth. Learn more about stillbirth.
Key points about miscarriage
- If you are pregnant and have vaginal bleeding or abdominal pain, contact your lead maternity carer (LMC) midwife or doctor.
- Light vaginal bleeding is relatively common during the first trimester (the first 3 months) and does not necessarily mean you're having a miscarriage, but all bleeding should be checked.
- Management of miscarriage depends on whether any pregnancy tissue remains in your womb, and can be conservative, medical or surgical.
- The loss of a pregnancy can be distressing. It’s normal to experience grief and to need time to recover from the emotional and physical impact.
What is miscarriage?
Miscarriage is a pregnancy that ends on its own before 20 weeks gestation. It is fairly common, affecting around 1 or 2 in every 10 pregnancies. Most miscarriages (more than 95%) occur in the first 12 to 14 weeks of pregnancy (the first trimester).
Often the cause of the miscarriage is not known.
The following medical terms are used to describe the different types of miscarriage:
- Complete miscarriage – this is when all the pregnancy tissue in your womb is cleared by your body naturally. Vaginal bleeding will continue for a while, similar to having a period. Because your body has completely cleared all the pregnancy tissue you do not need any treatment.
- Incomplete miscarriage – this is when some of the pregnancy tissue remains in your womb. You may experience pain and bleeding.
- Missed miscarriage – sometimes a pregnancy ends with little or no sign that anything is wrong. An ultrasound scan shows that the pregnancy tissue remains in your womb, but the pregnancy does not progress.
Why does miscarriage occur?
Miscarriage is usually a natural process. The chain of events from conception through early pregnancy is complex. Most miscarriages occur because something happened with the development of the baby during or soon after conception. This could be related to a problem with cell development as the baby forms, the health of the mother, infection or issues with the development of the placenta.
What are the signs of miscarriage?
Signs of miscarriage depend on the stage of pregnancy. During the first few weeks of pregnancy, the only sign of miscarriage is bleeding that looks like a heavy period. You might not even know you were pregnant. Later, miscarriage often includes painful cramps and bleeding.
Sign of miscarriage include:
- vaginal bleeding, which varies from light spotting to heavy bleeding
- fluid, blood clots or tissue passing from your vagina
- abdominal pain or cramping
- lower back pain
- fever and chills (this may indicate infection).
Once you know you are pregnant, speak to your LMC midwife or doctor if you have any bleeding from your vagina, or if you think you may be having/have had a miscarriage.
Keep in mind that light vaginal bleeding is relatively common during the first trimester (first 3 months) of pregnancy and does not necessarily mean you're having a miscarriage, but all bleeding should be checked.
What should I do if I think I am miscarrying?
If you are concerned that you may be starting to miscarry or you are having any vaginal bleeding and/or pain contact your LMC midwife or doctor. They will tell you what to do.
Go to the emergency department at the local hospital if your bleeding is heavy (soaking pads in an hour or less) and/or if you are passing blood clots and/or having pain. If you are alone and things are happening fast, dial 111 and ask for an ambulance. Never drive yourself to hospital if you think you are having a miscarriage.
What can my LMC midwife or doctor do if I'm pregnant and bleeding?
If you are pregnant and experiencing light vaginal bleeding, your LMC midwife or doctor will probably organise an ultrasound to help assess whether your pregnancy is healthy. An ultrasound can help determine whether:
- there is a fetal heartbeat
- the amniotic sac that surrounds the fetus is normal
- the pregnancy is ectopic (occurring outside your uterus, such as in one of the fallopian tubes)
- you may have spontaneously aborted one fetus in a twin or triplet pregnancy.
Unfortunately, your healthcare provider can’t stop you from miscarrying.
How is a miscarriage confirmed?
An ultrasound scan is the most accurate way of confirming a miscarriage. It will also show whether there is any pregnancy tissue remaining in your womb.
You may also be asked to take a pregnancy test (by a urine or blood sample) but be aware it can take time for the hormones in your body to return to normal after a miscarriage, so you may feel pregnant and your pregnancy test may still be positive for a while.
How is a miscarriage managed?
If the miscarriage is complete and all pregnancy tissue has been cleared naturally by your body, no further treatment will be required. The earlier you are in the pregnancy, the more likely that your body will clear all the pregnancy tissue by itself and that you won’t require further medical procedures.
When your body doesn’t clear all the tissue it is called an incomplete miscarriage.
Treatment options for incomplete miscarriage can be conservative, medical or surgical. If not cleared, an incomplete miscarriage can make you very ill and may also have an effect on future pregnancies.
Conservative (also known as expectant management)
This is a where you wait for nature to take its course and clear the tissue from your body naturally. This could take days or weeks to occur and you will need to see your GP for monitoring. If your womb doesn’t empty completely you may require medical treatment.
This involves the use of medicine call misoprostol to speed up the natural process of miscarriage. Misoprostol is a medicine in the same group as prostaglandin, which is used to induce labour. Misoprostol stimulates your womb to contract and empty itself. Most women experience moderate to severe abdominal pain and heavy vaginal bleeding. Sometimes bleeding begins straight away, but sometimes it can take 2 to 3 days or longer. You will be given the medicine in hospital then can go home, so long as you have an adult with you. You may need to take another dose of the medicine by mouth the next day and have a blood test 2 weeks later.
An evacuation of your uterus, also known as a D&C, is a surgical procedure to remove the pregnancy tissue. The procedure can be done under either general or local anaesthetic. You need a hospital visit of about 3 hours for the procedure. Some of the reasons this may be recommended are if you have:
- very heavy bleeding with low blood pressure or low blood count
- signs of infection
- not been able to clear the pregnancy tissue through conservative or medical management
- an intrauterine contraceptive device (IUCD) in your uterus
- recurrent miscarriage (3 or more)
- a history of severe illness
- lost a pregnancy of more than 12 weeks.
What can I do to take care of myself after a miscarriage?
A miscarriage can be a difficult time. Give yourself time to recover physically and to come to terms with what has happened emotionally. If you experience a miscarriage:
- rest as much as you can, especially in the first few days
- reach out and talk to someone you trust
- take a look at the list of online support options below
- avoid swimming and spa pools, and shower instead of bathing
- use sanitary pads instead of tampons and avoid sex (or use a condom) while you are still bleeding – this reduces the risk of infection
- if the miscarriage is complete, you can expect the bleeding to get lighter and lighter and stop in about 1 week
- tell your LMC immediately if you experience fever and chills, pain or if there is an odour – you may have an infection which requires treatment.
When can we try for a baby again?
This depends very much on the circumstances and nature of your miscarriage. It’s best you discuss this with your LMC midwife or doctor. Most women who have miscarriages go on to have normal pregnancies and healthy babies.
What if I keep having miscarriages?
If you experience 3 miscarriages in a row, talk to your doctor. You may need to undergo medical tests to try and find out any underlying conditions that may be causing the miscarriages.
Support for bereaved parents, families and whānau throughout New Zealand Sands, NZ
After miscarriage Miscarriage Support, NZ
Miscarriage NZ College of Midwives
|Dr Alice Miller trained as a GP in the UK and has been working in New Zealand since 2013. She has undertaken extra study in diabetes, sexual and reproductive healthcare, and skin cancer medicine. She is looking forward to further study with Otago University in public health to learn about how we can reduce preventable disease and inequalities.|