What is early pregnancy loss?
An early pregnancy loss is known as a miscarriage. This represents any pregnancy that ends on its own in the first 20 weeks of gestation. Experts estimate that 10% to 20% of known pregnancies end in miscarriage. There are several classifications of miscarriage:
- Complete – when the embryo and surrounding tissues have emptied out of the uterus. It typically involves cramping and bleeding. These resolve quickly, usually in a few days to a week.
- Incomplete or inevitable – when the cervix opens, and some tissue is expelled (released). The embryo or tissue may not completely leave the uterus. This can cause continued pain and bleeding.
- Missed – when the embryo has died, but it stays in the uterus. You may have no idea that it has happened. It is often discovered when pregnancy symptoms stop, or an ultrasound shows no heartbeat.
- Threatened – when you experience some bleeding and cramping, but the cervix remains closed. A miscarriage may or may not happen.
- Recurrent –when you have 3 or more miscarriages in your first trimester.
Other problems can also result in an early pregnancy loss:
- Chemical pregnancy – This is a very early miscarriage. It usually happens in the first few weeks after conception. Chromosomal abnormalities keep the embryo from developing normally. The tissue is passed from your uterus around the same time that you normally have your period. Many women don’t even know they are pregnant when they have a miscarriage from a chemical pregnancy.
- Blighted ovum –This is also called an embryonic pregnancy. It happens when the fertilized egg implants in the wall of the uterus, but a fetus never develops.
- Ectopic pregnancy –This is when the fertilized egg implants somewhere other than the uterus. Often, it implants in the fallopian tube. This can cause serious problems for the mother. Treatment — usually surgery — is needed right away to remove the tissue. This is never a viable pregnancy.
- Molar pregnancy –This is a rare problem that starts with a genetic error during fertilization. This causes abnormal tissue to grow instead of an embryo. It is not a viable pregnancy. But it still causes regular pregnancy symptoms. These include a missed period, positive pregnancy test, and nausea.
Symptoms of early pregnancy loss
The most common symptoms of miscarriage are bleeding and cramping. But they don’t necessarily mean you’re having a miscarriage. Up to one-third of pregnancies come with some bleeding early on. About half of those result in normal pregnancies. If you have any bleeding or cramping in your first trimester, call your doctor.
There are other common signs that indicate you may be having a miscarriage. If you experience any of these symptoms, call your doctor right away:
- Mild to severe back pain (worse than menstrual cramps)
- Weight loss
- White-pink mucus discharge from the vagina
- Contractions (painful, happening every 5 to 20 minutes)
- Tissue that looks like a clot passing from the vagina
- Sudden decrease in signs of pregnancy
What causes early pregnancy loss?
In some cases, the cause of your pregnancy loss is unknown. Often, it is a random problem with chromosomes that happens at conception. You might be afraid that you did something that caused your miscarriage. But things like working, exercising, having sex, or morning sickness do not cause miscarriage. Any kind of fall or blow is rarely to blame. The research on the effects of alcohol, tobacco, and caffeine is unclear. So, there is nothing you could have done to prevent it. It is not the result of anything you did or didn’t do. You should never blame yourself for a miscarriage.
How is early pregnancy loss diagnosed?
Your doctor will start by asking you questions about your symptoms and when they started. They will do a physical exam. Your doctor might do an ultrasound. This can reveal if the embryo is still growing, and it can check for a heartbeat. They may also order blood tests. These can measure pregnancy hormone levels. This can give your doctor an idea if you are losing the pregnancy.
Can early pregnancy loss be prevented or avoided?
There is no conclusive research that says there is anything you can do to prevent a miscarriage. You didn’t cause it, so you couldn’t have prevented it.
Risk factors
Patients who are pregnant and who have had a miscarriage are at greater risk of having another one. Your risk also increases as you get older. You are at highest risk when you are age 35 or older. Some medical conditions also increase your risk. These include:
- Diabetes.
- Thyroid disease.
- Polycystic ovary syndrome.
- Problems with the immune system.
Even if you have one of these conditions, you can’t do anything to avoid having a miscarriage. Many patients who are pregnant and have these health conditions have healthy pregnancies.
Early pregnancy loss treatment
There are two main types of treatment for miscarriage: non-surgical and surgical.
Non-surgical
In many cases, your body passes all of the pregnancy tissue naturally. This could take a few days up to a few weeks. No treatment is needed. If it is taking a long time, your doctor can give you medicine that can help pass the tissue.
The process of passing the tissue can involve heavy bleeding, cramping pain, diarrhea, and nausea. Your doctor may give you pain medicine to help ease your symptoms. If you are in your first trimester, the tissue will be small. It will look like a blood clot. It will not look like a baby.
Your doctor may do an ultrasound or blood tests after you are finished with the miscarriage. This will confirm that the miscarriage is complete, and no tissue remains.
Surgical
Surgical treatment is usually done if there are complications with your miscarriage.
Complications could include:
- An infection
- Heavy bleeding
- Any condition that keeps pregnancy tissue inside your uterus
Common surgical treatments include:
- Vacuum aspiration.In this procedure, a thin tube is inserted into your uterus. It is connected to a suction device. The pregnancy tissue is suctioned out of your body. The procedure is done under local anesthesia. Your doctor can perform it in his or her office.
- Dilation and curettage (D&C).This procedure opens the cervix and uses an instrument to remove the pregnancy tissue. It is usually done under regional or general anesthesia. Your doctor will perform it in a hospital or surgery center.
After treatment, your doctor may recommend you not put anything into your vagina for a few weeks. This includes using tampons and having sex. This helps prevent infection. Signs of infection include:
- Heavy bleeding
- Fever
- Chills
- Severe pain
Call your doctor right away if you have any of these symptoms.
Living with early pregnancy loss
Everyone handles loss differently. Some patients who are pregnant may have trouble coping with the feelings that can go along with miscarriage. If you are very upset or feel like you need help, there are resources available. Talk to your doctor. They may be able to refer you to a local support group. There are also national resources you can access, such as SHARE: Pregnancy and Infant Loss Support. It lists local support groups and offers online resources that could help you.
Questions to ask your doctor
- I’m having symptoms of miscarriage. What are the chances that I will miscarry?
- How will I know what caused my early pregnancy loss?
- Is there an advantage to letting the tissue pass naturally over having a D&C?
- Will a miscarriage affect my ability to get pregnant again?
- How long should I wait after an early pregnancy loss to try to get pregnant again?
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.
