Miscarriage is the end of a pregnancy that happens spontaneously before week 20 of gestation. It is very common, and occurs in about one in five pregnancies in Australia. Most miscarriages occur during the first 12 weeks of pregnancy.
Recurrent miscarriages are when you lose three or more pregnancies in a row. This is uncommon and affects only one in every 100 cases. If you have a miscarriage, even recurrent miscarriages, it's unlikely that you have an underlying medical problem. Most women go on to have successful, full-term pregnancies in the future.
The different types of miscarriage are:
The most common symptom of a miscarriage is bleeding from your vagina. This can vary from light spotting to bleeding that is heavier than your period. You may see blood clots or a brown discharge. You can also have cramps and pain in your abdomen (tummy), pelvis or back.
Some people don’t have any symptoms and their miscarriage may only be discovered in a routine scan.
If you have bleeding from your vagina at any time during pregnancy, contact your GP or midwife immediately for advice.
About half of all early miscarriages happen because of a problem in the way your genetic material (chromosomes) combined when your egg and your partner's sperm joined during fertilisation. You may never find out why this has happened, but it's likely to be due to chance than to any underlying problem with either you or your partner.
Other factors that can make a miscarriage more likely include:
There isn't any evidence to show that stress is a risk factor for miscarriage, but it's a good idea to take time during the day to relax.
Moderate exercise or having sex while you're pregnant doesn't increase your risk of miscarriage.
Often you won't know what has caused your miscarriage. Unfortunately, if you have already started to miscarry there is nothing that can be done to prevent it.
Your doctor will ask about your symptoms and examine you. He or she may also ask you about your medical history.
Your GP may refer you to a gynaecologist (a doctor who specialises in women's reproductive health), or to an early pregnancy assessment unit at a hospital to have further tests, including:
If you have recurrent miscarriages, your GP may refer you and your partner to a gynaecologist to have some tests in order to rule out a specific cause. Possible causes include a hormonal disturbance, inherited problems and abnormalities of the womb or a condition where your body's own defence mechanism attacks itself, leading to blood clots forming in the placenta.
If your miscarriage is complete, you won't usually need any further treatment. For an incomplete or missed miscarriage, or when you have a lot of bleeding, you may need treatment with medicines or surgery to remove the remaining foetal tissue. However, some women prefer to let nature take its course — this is called expectant management (see below).
Your chances of having a healthy pregnancy in the future are just as good whichever method you choose.
This allows the pregnancy to leave your body naturally. It can take some time before any bleeding starts and it’s normal for this to continue for up to three weeks, along with tummy cramps. You may need to take medicines or have surgery if this method isn’t successful.
Medical treatment involves medicines that cause your cervix to open and allow foetal tissue to pass out. You may be advised to swallow tablets or a pessary can be inserted directly into your vagina. The effects of the tablets usually begin within a few hours. You will experience symptoms similar to a heavy period, such as cramps and vaginal bleeding. The bleeding can continue for several weeks, although it won’t be heavy for very long.
You may need to have surgery if medicines are unsuccessful at removing all the tissue.
Whether or not you need surgery to remove any tissue will depend on the stage of your pregnancy, the amount of bleeding you're having, and your preferences. Surgery for miscarriage is a short procedure to empty your womb. It's known as an evacuation of retained products of conception (ERPC). Your surgeon will pass a soft plastic tube through your cervix into your womb and the remaining tissue will be removed by suction.
The operation is usually done as a day surgery under general anaesthesia. This means you will be asleep during the operation. Alternatively, you may be given the option of local anaesthesia. This blocks pain from the area and you will stay awake during the operation.
ERPC is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications. These include:
Ask your surgeon to explain these risks to you.
If you have a miscarriage between 14 and 24 weeks, you will probably have to go through labour and delivery. The miscarriage may be spontaneous, or labour may need to be induced. You will have some bleeding and possibly period-like pain in the days after the delivery and for several weeks. Your breasts may produce milk.
It may be possible to have a post-mortem on your baby which may provide information about what caused the miscarriage and possibly help your doctor to care for you if you have a future pregnancy.
Every pregnancy is at risk of miscarriage; however, if you drink alcohol or smoke, your risk is higher (see section on Causes of Miscarriage).You can help to reduce your risk of pregnancy problems by eating a balanced diet, losing any excess weight and by not drinking too much or smoking.
The physical effects of a miscarriage tend to clear up quickly. Your next period is likely to follow between four and eight weeks later, but it may take several cycles to re-establish a regular pattern.
You may feel physically ready to return to normal activities (such as exercising and going back to work) around a week after an operation, or a few days after treatment with medicines or expectant management. However, the emotional impact of having a miscarriage can be much greater than the physical effects. A miscarriage can cause a range of feelings. Everyone reacts differently and there is no right or wrong way to feel. It can be equally difficult for your partner and it’s important to get the support you both need. You could consider contacting support groups where you can talk with people who may have similar experiences to you.
You may decide to begin trying for another baby right away or you may think this is too soon and you need longer to recover emotionally. There is no right or wrong thing to do, you need to do what you feel is best for you and your partner. You may be advised by your doctor to wait until you have had at least one period before trying again, although it's safe to have sex when the bleeding and any other symptoms have completely settled and you both feel ready.
The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
Reproductive Loss Services, The Royal Women’s Hospital
(03) 8345 2498
SANDS Australia — Miscarriage, stillbirth and neonatal death support
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Last published: 31 July 2011
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