Miscarriage Management
What is miscarriage?
Miscarriage is spontaneous pregnancy loss prior to the 20th week of gestation, commonly occurring before the 12th week of pregnancy. It’s estimated that between 10-20 percent of confirmed pregnancies will end in miscarriage, making it a very common experience.
Cramping or bleeding are sometimes, but not always, signs of a miscarriage. Because pregnancy loss is a serious event that requires management by medical professionals, pregnant patients who experience these symptoms, or who otherwise suspect they might have had a miscarriage, should see their doctor.
Going through miscarriage can be both a physical and an emotional loss. Though miscarriage is relatively common, stigma surrounding miscarriage makes it difficult to discuss. Miscarriage is an unfortunate reality of family planning; it’s important to acknowledge loss, to find support if necessary and to allow the patient and their family the chance to grieve.
Having a miscarriage does not mean that a patient cannot have children in the future. A patient’s physician can evaluate their condition and discuss considerations for future pregnancy.
Causes of miscarriage
The cause of a this kind of pregnancy loss is often unidentified. Known causes can be trauma, obesity, drug or alcohol abuse and genetic abnormalities. In fact, the American Pregnancy Association suggests that a majority of miscarriages are the result of chromosomal abnormalities in the embryo.
While the specific cause of most incidents is never known, there are a number of risk factors that increase the potential for miscarriage. These include:
- Age (see below)
- Smoking
- Alcohol abuse
- Recreational drug use and prescription drug abuse
- Illness or infection
- Chronic health conditions such as uncontrolled diabetes
- Being overweight or underweight
- Immune response
- Hormonal problems
- Structural abnormalities
- Other uterine or cervical problems
- Chromosomal abnormalities not inherited from a parent
- Trauma
- Exposure to external toxins.
The risk for this form of pregnancy loss increases as patients age, starting at age 30 and increasing between ages 35 to 40. Patients over the age of 40 are at the greatest risk.
Symptoms of miscarriage
Symptoms of miscarriage include:
- Vaginal spotting or bleeding
- Abdominal or lower back pain
- Abdominal cramps
- The passing of tissue or clot-like material from the vagina.
Not all spotting or bleeding is indicative of miscarriage, but it’s important to contact a doctor with any questions or concerns. Patients who suspect they’ve had a miscarriage should contact their doctor immediately.
Medical management and complications of miscarriage
If a patient suspects or knows they have had a miscarriage, it is not time to go it alone. Medical evaluation and management of their condition is needed.
If tissue was passed through the vagina, it can be tested to confirm whether a miscarriage has occurred. It is not uncommon for a healthcare provider to perform a pelvic exam or abdominal ultrasound to determine whether any tissue remains in the uterus. Tissue that has not left the uterus naturally will need to be removed to prevent infection. This is done with medication or dilation and curettage (D&C).
If an infection occurs, symptoms may include fever, abnormal bleeding, cramping and foul-smelling discharge. It’s especially important to see a doctor if these symptoms are present.
A physician might also test human chorionic gonadotropin (hCG) levels to determine if a miscarriage has occurred. During the early stages of pregnancy, the concentration of hCG in a patient’s blood increases, peaking at about 8-10 weeks. That level will fall in the event of a miscarriage.
If a patient miscarries, it most often is not a reason to give up on conceiving, and it’s often possible to become pregnant again rather quickly. However, a majority of medical professionals recommend waiting at least one menstrual cycle before trying again. It may also be helpful to seek a counselor to assist with the emotional loss that can accompany the physical loss of miscarriage.
Miscarriage and unintended, unconfirmed pregnancy
It is not uncommon for a patient to miscarry before they know they are pregnant. While an estimated 10-20 percent of confirmed pregnancies result in miscarriage, it’s believed that a significant number of unconfirmed pregnancies, both intended and unintended, also result in miscarriage.
If a patient suspects they have experienced a miscarriage as the result of an unintended pregnancy, it’s also important to visit a doctor for examination. After a miscarriage, it can be helpful to work with a medical professional to develop a personalized contraceptive strategy.
Learn more about your birth control options