If a pregnancy ends before the 24th week, it is known as a miscarriage. Miscarriages are quite common in the first three months of pregnancy and around one in five confirmed pregnancies ends this way. Many early miscarriages happen because there is something wrong with the baby, such as a chromosomal abnormality. There can be other causes of miscarriage, such as medical problems.
A later miscarriage may be due to an infection, a poorly developed placenta or a weak cervix that opens too early in the pregnancy.
Symptoms of miscarriage
A miscarriage in the first few weeks can start like a period, with spotting or bleeding and mild cramps or backache. This can progress to heavy bleeding with blood clots and quite severe cramping pains. With a later miscarriage, you may go through an early labour.
If you bleed or begin to have pains at any stage of pregnancy, contact your GP or midwife. You should also contact your local early pregnancy unit (though they may want a referral from your GP before they see you). Find hospital maternity units near you.
If you are more than six weeks pregnant, you may be referred for an ultrasound scan to see if your baby has a heartbeat. Sometimes the bleeding stops by itself and your pregnancy will carry on quite normally. Find out more about bleeding and pain in early pregnancy.
Some women find out that their baby has died only when they have a routine scan. If they have had no pain or bleeding, this can come as a terrible shock, especially if the scan shows that the baby died days or weeks before. This is called a missed miscarriage, or sometimes a silent miscarriage.
Some women find out at a routine scan that they have a molar pregnancy, which means the pregnancy has not been successful and a baby will not develop. This is not the same as a miscarriage. Surgery is needed to remove the molar pregnancy and careful follow up is required to ensure all the pregnancy has been removed.
Treatment for a miscarriage
There are three ways a miscarriage can be managed.
Watching and waiting
This involves waiting 7-14 days for the products of pregnancy to be passed naturally.
Pills to empty the womb
This involves emptying the womb using vaginal (prostaglandin) tablets. Depending on the circumstances these may work better if preceded by another tablet (mifepristone) taken by mouth. The pregnancy is passed vaginally.
Surgery to empty the womb
This involves emptying the womb by an operation. This is usually done under general anaesthetic but some units also offer surgical evacuation under local anaesthetic. The procedure involves gently opening the neck of the womb and removing the products of conception (pregnancy) by suction.
See treatment of miscarriage for more details about each of these methods. There are benefits and risks of each option that you should consider when making your decision.
If you have surgery, any bleeding or pain you are experiencing because of your miscarriage should quickly improve. However, all surgical procedures carry their own risks. Medication avoids the need for surgery but can cause increased pain and bleeding. Waiting for the tissue to pass naturally avoids taking medication or having surgery but can take several weeks. It is also possible that not all of the tissue will be passed, and that you will later require surgery.
Discuss the options with the doctor in charge of your care.
Your fertility after a miscarriage
One early miscarriage is unlikely to affect your chances of having a baby in the future. If you have three or more early miscarriages in a row, you should be referred to a specialist for further investigations. However, sometimes no clear cause can be found.
Both women and men can find it difficult to come to terms with a miscarriage at any stage. You will almost certainly feel a sense of loss. You'll need time to grieve over the lost baby just as you would over the death of anyone close to you, especially if the miscarriage has happened later in your pregnancy.
Recovering from miscarriage
You may feel shocked, distressed, angry or just numb. You may feel guilty, wondering whether your miscarriage was caused by anything you did or did not do. It is important to know that, whatever the cause, miscarriage is never anyone's fault. If a miscarriage is going to happen, there is very little that anyone can do to stop it.
Some people find it helps to have something to remember their baby by. In early pregnancy you might be able to have a picture of a scan. If you have a late miscarriage you may be able to see and hold your baby if you wish. You might also be able to take photographs, footprints and handprints as a keepsake. Some hospitals offer parents a certificate to commemorate their baby. This is done because there is no formal registration of a baby who dies before 24 weeks of pregnancy.
Talk about your feelings with your partner and those close to you. You might also want to contact The Miscarriage Association or Sands (Stillbirth & neonatal death charity).They can give you information and put you in touch with other women who have experienced a miscarriage.
Healthtalk online has videos and written interviews of women talking about their experiences of miscarriage.