Miscarriage

A miscarriage is the loss of a pregnancy during the first 20 weeks of gestation. Miscarriages are very common. It is estimated that approximately 1 out of 4 pregnancies end in a miscarriage.

Losing a pregnancy can be an emotional experience. You may or may not experience feelings of grief, anxiety, or guilt. Not all women react to miscarriage in the same way. Learning more about miscarriage can help you to make informed decisions about your health. Treatment options may assist you in coping with your miscarriage. What causes a miscarriage?

The majority of miscarriages occur because the fertilized egg or fetus does not develop as expected. Often, it is not possible for health care professionals to determine why this happens.

Miscarriages are not caused by exercise, sex, stress, or lifting heavy objects. Vomiting and nausea experienced in the early stages of pregnancy cannot cause a miscarriage. Injuries or falling down are also unlikely to result in a miscarriage, unless the injuries pose a threat to your own life.2

Although avoiding certain risk factors may help lower your risk of having a miscarriage, most miscarriages cannot be prevented. Recognizing the symptoms of miscarriage and consulting a health care provider will help you to find out if you are having or had a miscarriage and what treatment may be necessary.

What factors might increase the risk of miscarriage?

• Age: women age 35 and older are more likely to experience a miscarriage.
• Previous miscarriages (2 or more): if you have miscarried only once, your chance of miscarrying again is the same as women who have never miscarried.3
• Health conditions: such as untreated infections, blood-clotting problems, thyroid disease, diabetes, lupus, and cervical or uterine problems (e.g. uterine fibroids, uterine polyps, polycystic ovary syndrome, etc.). 4
• Smoking, drinking alcohol, and using drugs.
• Chemicals: consistent exposure to certain chemicals can increase the risk of miscarriage.
• Medication: certain medications, such as ibuprofen, naproxen, and other non-steroidal anti-inflammatory drugs, should be avoided during pregnancy. Consult a health care professional about which medications you should avoid and carefully read the instructions, including a list of possible side effects and contraindications, provided with your medication.5
• High intake of caffeine: consuming large amounts of caffeine (i.e. more than 3 cups a day) during your pregnancy might increase your risk of having a miscarriage. For more information on avoiding or limiting caffeine intake during pregnancy, visit the BC Health Guide.
• Herbs: taking certain herbs or herbal remedies, such as Black or Blue Cohosh, during pregnancy may increase the risk of miscarriage. For more information about which herbal remedies to avoid during pregnancy, consult a qualified health care professional and the Society of Obstetricians and Gynaecologists of Canada.

What are the symptoms of miscarriage? 

• Vaginal bleeding: bleeding can range from light to heavy and may be irregular or constant. Bleeding is not always a sign of miscarriage, but bleeding accompanied by pain is more likely to indicate a miscarriage.
• Pain: lower back pain (a continual, dull aching sensation), abdominal pain, or cramps in your pelvic area could be signs of a miscarriage, especially if accompanied by vaginal bleeding.
• Tissue or blood clots passing from the vagina.6

It is possible to have a miscarriage without realizing it, especially in the early stages of pregnancy. Typically, a miscarriage happens over several days. If you experience symptoms of a miscarriage, seek medical attention immediately. A health care professional can perform a pelvic examination and specific tests (i.e. a blood test or ultrasound) to diagnose if you are having a miscarriage.

How are miscarriages treated?

If you experience symptoms of a miscarriage but your pregnancy is still progressing, your health care provider may recommend that you rest and avoid sexual activity, exercise or other strenuous activity until your symptoms subside.

Once a miscarriage has been confirmed, it cannot be reversed; however, a health care professional can help you to determine whether or not you require treatment and, if so, what type of treatment you might need.

If you experience heavy vaginal bleeding and signs of shock, such as weakness, lightheadedness or dizziness, confusion, sudden changes in body temperature, a sudden increase in heart rate, and nausea or vomiting, seek professional medical attention immediately (i.e. contact emergency services in your area).

Treatment options for miscarriage include:

• Expectant management. This involves allowing the miscarriage to complete on its own. This process takes longer to complete than other treatment options (i.e. several or more days). During this time it is important to monitor your health and inform your health care provider of any changes in your condition.
• Medical treatment. If you are experiencing severe pain or bleeding or the miscarriage is progressing very slowly and causing you discomfort, you may want to consult a health care professional about taking misoprostol to complete the miscarriage. Misoprostol, taken orally or administered vaginally, causes the uterus to empty. Common side effects of misoprostol include nausea, vomiting, and diarrhea. For a complete list of side effects, consult a health care provider.7
• Surgical treatment. A minor surgical procedure, called dilation and curettage (D&C), can also be used to complete a miscarriage. During a D&C, the cervix is dilated and tissue is gently suctioned from the uterus. An instrument called a curet may also be used after the suctioning to complete the procedure.8 D&C provides the quickest treatment for a miscarriage and may be necessary if you are experiencing heavy bleeding or develop an infection.

A health care professional may recommend medical or surgical treatment if you experience an incomplete miscarriage (i.e. some or all of the fetal tissue remains in the uterus following pregnancy loss). Managing a miscarriage with the assistance of a health care professional is important to make sure you do not acquire an infection.

1 Healthwise. 2005. “Miscarriage – Topic Overview.” BC Health Guide. Retrieved November 26, 2007. <http://www.bchealthguide.org/kbase/topic/mini/hw44090/overview.htm>
2 Mayo Clinic Staff. 2006. “Understanding miscarriage.” Mayo Foundation for Medical Education and Research (MFMER). Retrieved November 26, 2007. http://www.mayoclinic.com/health/miscarriage/PR00097
3 Ibid.
4 Ibid.
5 Healthwise. 2005. “Miscarriage – Symptoms.” BC Health Guide. Retrieved, November 26, 2007. http://www.bchealthguide.org/kbase/topic/mini/hw44090/symptoms.htm
6 Ibid.
7 Healthwise. 2005. “Misoprostol”. BC Health Guide. Retrieved, November 27, 2007. http://www.bchealthguide.org/kbase/topic/detail/drug/tw9126/detail.htm
8 Mayo Clinic Staff. 2006. “Understanding miscarriage.” Mayo Foundation for Medical Education and Research (MFMER). Retrieved November 27, 2007. http://www.mayoclinic.com/health/miscarriage/PR00097