Early miscarriage
This information is for you if you want to know more about miscarriage in the first 3 months of pregnancy. It may also be helpful if you are a relative or friend of someone who has had an early miscarriage. Losing a baby is a deeply personal experience that affects people differently. It can be very distressing, and you may need a great deal of support afterwards. Don’t hesitate to talk to your provider for support options.
What is an early miscarriage?
If you lose your baby in the first 3 months of pregnancy, it is called an early miscarriage. Most women experience vaginal bleeding but occasionally there may be no symptoms. If this is the case, the miscarriage may be diagnosed by an ultrasound scan.
Why do early miscarriages happen?
In most cases, it is not possible to give a reason for an early miscarriage. The most common cause is thought to be a problem with the baby’s chromosomes (the genetic structures within the body’s cells that we inherit from our parents). If a baby does not have the right number of chromosomes, it will not develop properly, and the pregnancy can end in a miscarriage.
What are my chances of having a miscarriage?
Sadly, early miscarriages are very common. Many early miscarriages occur before a woman has missed her first period or before her pregnancy has been confirmed. In the first 3 months, one in five women will have a miscarriage, for no apparent reason, following a positive pregnancy test.
The risk of miscarriage is increased by:
your age – at the age of 30, the risk of miscarriage is one in five (20%); over the age of 40, the risk of miscarriage is one in two (50%) medical problems such as poorly controlled diabetes lifestyle factors such as smoking, being overweight or heavy drinking. There is no evidence that stress can cause a miscarriage. Sex during pregnancy is not associated with early miscarriage.
What should I do if I have bleeding and/or pain in the first 3 months?
Vaginal bleeding and/or cramping pain in the early stages of pregnancy are common and do not always mean that there is a problem. However, bleeding and/or pain can be a sign of a miscarriage. If you have any bleeding and/or pain, call your provider.
How is an early miscarriage diagnosed?
An early miscarriage is usually diagnosed by an ultrasound scan. You may be advised to have either a transvaginal scan (where a probe is gently inserted in your vagina) or a transabdominal scan (where the probe is placed on your abdomen) or occasionally both. A transvaginal scan may be recommended as it gives a clearer image. Neither scan increases your risk of having a miscarriage.
You may be offered blood tests that could include checking the level of your pregnancy hormone (βhCG). If you are bleeding or have pain, a vaginal examination may be carried out. You should be offered a chaperone (someone to accompany you) for a vaginal examination or a transvaginal scan. You may also wish to bring someone to support you during your examination or scan.
Some women will miscarry quite quickly but for others the diagnosis and ongoing management may take several weeks.
What are my choices if a miscarriage is confirmed?
If your ultrasound scan shows that you have miscarried and nothing remains in your womb, you may not need any further treatment. If the miscarriage is confirmed but some or all the pregnancy is still inside your womb, your healthcare professional will talk to you about the best options for you. You may choose to wait and let nature take its course, or to use medicines or to have an operation.
1. Letting nature take its course (expectant management of a miscarriage)
This is successful in about 50 out of 100 women who choose this option. It can take some time before the bleeding starts and this may continue for up to 3 weeks. It may be heavy, and you may experience cramping pain. If you have severe pain or very heavy bleeding, you may need to be admitted to hospital. You should be given a follow-up appointment about 2 weeks later. If the bleeding and pain has settled by then, it is likely that all the pregnancy has come away.
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If bleeding fails to start within 7–14 days or is persisting or getting heavier, you will be offered a further ultrasound scan. The options of continuing expectant management, medical treatment or having an operation will then be discussed with you.
2. Taking medication (medical management of a miscarriage)
This is successful in 85 out of 100 women and avoids an anesthetic. You will be given medication called misoprostol, usually to be inserted in the vagina although tablets to swallow may be taken if you prefer. The medication helps the neck of the womb (cervix) to open and lets the remaining pregnancy come away. It will take a few hours and there will be some pain with bleeding or clotting (like a heavy period). You will be offered pain relief and anti-sickness medication. Some women may experience diarrhea and vomiting.
After the treatment, you may bleed for up to 3 weeks. If the bleeding is heavy, you should contact your provider. If the treatment has not worked, you will be given the option of having an operation.
3. Having an operation (surgical management of a miscarriage)
The operation may be carried out under general or local anesthetic. It is successful in 95 out of 100 women. The pregnancy is removed through the cervix. You may be given tablets to insert in the vagina before the operation to soften your cervix. Surgery will usually take place within a few days of your miscarriage, but you may be advised to have surgery immediately if:
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you are bleeding heavily and continuously
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there are signs of infection
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medical treatment to remove the pregnancy has been unsuccessful
The operation is safe but there is a small risk of complications including heavy bleeding, infection or damage to the womb. A repeat operation is sometimes required. The risk of infection is the same if you choose medical or surgical treatment.
4. What happens to the pregnancy remains?
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Some tissue removed at the time of surgery may be sent for testing in the laboratory. The results can confirm that the pregnancy was inside the womb and not an ectopic pregnancy (when the pregnancy is growing outside the womb). It also tests for any abnormal changes in the placenta (molar pregnancy).
What happens next?
Vaginal bleeding
You can expect to have some vaginal bleeding for 1–2 weeks after your miscarriage. This is like a heavy period for the first day or so. This should lessen and may become brown in color. You should use sanitary towels rather than tampons, as using tampons could increase the risk of infection. If you normally have regular periods, your next period will usually be in 4–6 weeks’ time. Ovulation occurs before this, so you may be fertile in the first month after a miscarriage. Therefore, if you do not want to become pregnant, you will need to use contraception.
Discomfort
You can expect some cramps (like strong period pains) in your lower abdomen on the day of your miscarriage. You may get milder cramps or an ache for a day or so afterwards. You should call your provider if:
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Heavy or prolonged vaginal bleeding, smelly vaginal discharge
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Severe abdominal pain not relieved by regular pain killers.
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Fever and flu-like symptoms
Emotional recovery
A miscarriage affects every woman differently and can be devastating for her partner too. Some women come to terms with what has happened within weeks; for others, it takes longer. Many women feel tearful and emotional for a short time afterwards. Some women experience intense grief over a longer time. Your family and friends may be able to help. Talk to your provider if you feel you are not coping.
Returning to work
When you return to work depends on you and how you feel. It is advisable to rest for a few days before starting your routine activities but returning to work within a day or two will not cause you harm if you feel well enough. Most women will return to work in a week, but you may need longer to recover emotionally.
Having sex
You can have sex as soon as you both feel ready. It is important that you are feeling well and that any pain and bleeding has significantly reduced.
When can we try for another baby?
You can try for a baby as soon as you and your partner feel physically and emotionally ready.
Am I at higher risk of a miscarriage next time?
You are not at higher risk of another miscarriage if you have had one or two early miscarriages. Most miscarriages occur as a one-off event and there is a good chance of having a successful pregnancy in the future. A very small number of women have a condition that makes them more likely to miscarry. If this is the case, medication may help.
Is there anything else I should know?
Like anyone else planning to have a baby, you should:
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Take 400 micrograms of folic acid every day from when you start trying until 12 weeks of pregnancy to reduce the risk of your baby being born with a neural tube defect (spina bifida)
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Be as healthy as you can – eat a balanced diet and stop smoking.
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Not drink alcohol as this may increase your chance of
Key points
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Early miscarriages are very common and one in five women have a miscarriage for no apparent reason.
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Bleeding and/or pain in early pregnancy can be a warning sign of miscarriage and you should seek medical advice if you are in this situation.
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You may be offered tests including an ultrasound scan to check your pregnancy.
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Once a miscarriage is diagnosed, your healthcare professional will tell you about your options, which include expectant, medical or surgical treatment.
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Most miscarriages are a one-off event and there is a good chance of a successful pregnancy in future.