Miscarriage refers to the premature end of a pregnancy before the developing baby is able to survive outside the uterus. Miscarriage can occur during the first or second trimester, before 20 weeks. Most occur in the first 12 weeks of pregnancy. They often are unexpected and isolated events. About 15%-20% of recognized pregnancies end this way.
Fetus in First Trimester
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Miscarriages often occur for the following reasons:
- Chromosomal abnormalities (common cause)
Abnormalities in the uterine tract, such as
- Hormonal problems, such as not having enough hormone (progesterone) needed to support pregnancy
- Factors related to the immune system, such as blood-clotting problems or rejection of the fetus
In some cases, the cause of miscarriage is unknown.
Miscarriages are more common in women 35 years and older. Other factors that may increase your chance of having a miscarriage include:
- Smoking, drinking
alcohol, or using
- Certain medications
- Exposure to certain environmental toxins
Autoimmune disorders, such as
systemic lupus erythematosus
on the ovaries, uterus, or the pituitary gland during treatment of childhood cancers
Miscarriage may cause:
- Vaginal bleeding
- Pink or brown discharge
- Passing the fetus, placenta, and surrounding membranes through the vagina
While miscarriage usually is a one-time occurrence, up to 1 in 20 couples experience 2 miscarriages in a row, and 1 in 100 have 3 or more.
In some cases, these couples have an underlying problem. Couples who have experienced 2 or more miscarriages should have a complete medical evaluation to learn the cause and how they can prevent another one from occurring.
Cause of repeat miscarriages may include:
- Chromosome problem in one member of the couple
- Uterine abnormalities
- Hormone problems
- Immune system problems
- Unknown causes
You will be asked about your symptoms, the length of your pregnancy, and when you first noticed a change in your condition. Physical and pelvic exams.
Prior to miscarriage, tests may include:
—to assess the health of the fetus
- Blood tests—to check the exact amount of the hormone (called human chorionic gonadotropin or hCG) important to sustain an early pregnancy
After miscarriage, tests may include:
- Examination of the tissue that has passed through the vagina
- Blood tests—to check for a chromosomal error in the man or the woman or to check hormone and antibody levels
Imaging tests may be used to evaluate the uterus and surrounding structures. These may include:
Immediate care usually involves observation only, especially in early or first trimester miscarriages. Medication may be indicated in the event of heavy bleeding or cramping.
A dilation and evacuation (D&E) may be needed if uterine contents are not spontaneously passed through the vagina. During a D&E, the doctor dilates the cervix, inserts a tool into the uterus, and suctions out remaining material.
A counselor or support group
may be needed to help deal with the emotions surrounding a miscarriage.
Before you start to plan your next pregnancy consider the following regarding your health:
- Is your diet ready to support another pregnancy?
- Are there habits you should change prior to another pregnancy?
- What medications are you taking and will they affect a pregnancy?
- How is your health?
- Are there issues you should resolve before trying another pregnancy?
If a specific cause of the miscarriage was found, certain treatments may help prevent future miscarriages. Treatments may include:
Medications such as:
- Antibiotics to treat related infections
- Hormone (progesterone) supplements
- Aspirin and other medications to treat blood-clotting problems
Surgery for uterine problems such as:
- Uterine fibroids
- Septate uterus (tissue in the center of the uterus)
- Incompetent (weakened) cervix
First trimester pregnancy loss. EBSCO DynaMed Plus website. Available at:
http://www.dynamed.com/topics/dmp~AN~T113658/First-trimester-pregnancy-loss. Updated March 17, 2017. Accessed September 8, 2017.
Miscarriage. American Pregnancy Association website. Available at:
http://americanpregnancy.org/pregnancy-complications/miscarriage. Updated MAy 2, 2017. Accessed September 8, 2017.
Miscarriage. March of Dimes website. Available at:
http://www.marchofdimes.com/loss/miscarriage.aspx. Updated July 2012. Accessed September 8, 2017.
Second trimester pregnancy loss. EBSCO DynaMed Plus website. Available at:
http://www.dynamed.com/topics/dmp~AN~T904101/Second-trimester-pregnancy-loss. Updated May 10, 2017. Accessed September 8, 2017.
Recurrent pregnancy loss. EBSCO DynaMed Plus website. Available at:
http://www.dynamed.com/topics/dmp~AN~T116364/Recurrent-pregnancy-loss. Updated March 17, 2017. Accessed September 8, 2017.
12/2/2008 DynaMed Plus Systematic Literature Surveillance
http://www.dynamed.com/topics/dmp~AN~T904411/Risk-factors-for-first-and-second-trimester-pregnancy-loss: Winther JF, Boice JD Jr, Svendsen AL, Frederiksen K, Stovall M, Olsen JH. Spontaneous abortion in a Danish population-based cohort of childhood cancer survivors. J Clin Oncol. 2008;26:4340-4346.
4/16/2009 DynaMed Plus Systematic Literature Surveillance
http://www.dynamed.com/topics/dmp~AN~T113658/First-trimester-pregnancy-loss: Bhattacharya S, Townend J, Shetty A, Campbell D, Bhattacharya S. Does miscarriage in an initial pregnancy lead to adverse obstetric and perinatal outcomes in the next continuing pregnancy? BJOG. 2008;115:1623-1629.
6/25/2010 DynaMed Plus Systematic Literature Surveillance
http://www.dynamed.com/topics/dmp~AN~T904411/Risk-factors-for-first-and-second-trimester-pregnancy-loss: Nakhai-Pour HR, Broy P, Bérard A. Use of antidepressants during pregnancy and the risk of spontaneous abortion. CMAJ. 2010;182(10):1031-1037
Last reviewed September 2017 by EBSCO Medical Review Board
Beverly Siegal, MD, FACOG
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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