Understanding Early Miscarriage
Early miscarriage refers to loss of a pregnancy in the first trimester. The majority of early miscarriages occur before the pregnancy is 10 weeks gestation. Some miscarriages happen very early, even before a woman is sure she is pregnant. Still, miscarriage can be a hard and sad experience, no matter when it occurs.
Miscarriage is more common than many people realize. About 10-20% of women who learn they are pregnant will have an early miscarriage. The rates of early miscarriage are even higher when women are checking home pregnancy tests very close to the time of their period and are finding a positive test VERY early. By chance alone, 1% to 4% of women will have two miscarriages in a row. However, it is very rare to have 3 or more miscarriages in a row, which is recurrent miscarriage (*link to recurrent miscarriage page).
In medical terms, early miscarriage is called an early pregnancy failure. This means that the pregnancy failed to develop. Almost all early miscarriages are due to circumstances beyond anyone’s control, and were destined to happen before the woman even knows she is pregnant.
Why see our specialists at UC Davis?
Our specialists can evaluate you quickly in an office setting. Any laboratory testing or ultrasound examinations that need to be done can be performed easily and conveniently. We perform our own ultrasound examination in the office and can share the results with you immediately. If we do confirm you have a miscarriage, we can discuss expectant management or treatment options with you immediately. Should you need blood testing to evaluate the pregnancy, the laboratory is in the same building as our office.
If you are having very heavy vaginal bleeding or are feeling very sick, you should go to the Emergency Room to see our physicians.
Symptoms of early miscarriage
- Bleeding – light bleeding early in pregnancy is fairly common, and does not mean you will have a miscarriage.
- Brown discharge: this may look like coffee grounds. This “discharge” is actually old blood that has been in the uterus for a while and is just coming out slowly.
- Spotting, bright red bleeding or clots
- Passage of tissue through the vagina
- A gush of clear or pink vaginal fluid
- Abdominal pain or cramping
- Pregnancy symptoms, such as breast tenderness and nausea, begin to go away
- Dizziness, lightheadedness, or feeling faint
If you have any symptoms of a miscarriage, you should contact a doctor right away to have an evaluation. It will be important to have an ultrasound exam to look into the uterus to see if the pregnancy is normal or you are having a miscarriage. Even if you think you passed the entire pregnancy and are feeling better, you should see a doctor. Sometimes, passing tissue occurs with an ectopic pregnancy (pregnancy outside of the uterus) which can be life-threatening if not diagnosed early.
Types of early miscarriage
Early miscarriage is a non-medical term for lots of different types of events that might or might not actually result in pregnancy loss. The types of miscarriage include the following:
- Threatened Miscarriage: Spotting or bleeding in the first trimester in which the patient and the doctor are not yet sure if the pregnancy will miscarry or not. About 1/3 of all women will bleed in the first trimester, but only about half of those women will have a miscarriage.
- Complete Miscarriage: the entire pregnancy is passed from the uterus, most commonly with bleeding and cramping, and no additional treatment or observation is needed.
- Incomplete Miscarriage: the pregnancy is definitely miscarrying, but only some of the pregnancy tissue has passed. The tissue that is still in the uterus will eventually pass on its own. Some women may need emergency treatment if there is also heavy vaginal bleeding. Otherwise, women can use medicines to cause the rest of the tissue to pass or simply wait for the rest of the tissue to pass from the uterus.
- Anembryonic Gestation: with this type of miscarriage, the pregnancy implanted but the embryonic tissue (the part of the pregnancy that will develop into a fetus) never developed, or started to develop and then stopped.
- Embryonic or fetal demise: with this type of miscarriage, the early embryo (or fetus once 10 weeks pregnant) stops developing and growing.
- Missed abortion: This is an uncommon type of miscarriage today. With a missed abortion, the pregnancy stops developing but the pregnancy tissue does not pass out of the uterus for at least 4 weeks. Sometimes, dark brown spotting or bleeding occurs, but there is no heavy bleeding.
- Septic Miscarriage: some miscarriages occur with an infection in the uterus. This is a serious condition that requires urgent treatment to prevent shock and death. With septic miscarriage, the patient usually develops fever and abdominal pain and may have bleeding and discharge with a foul odor. Antibiotics and suction evacuation of the uterus are important to start as quickly as possible.
What causes early miscarriage?
Almost nothing you can do will cause an early miscarriage. Avoiding sex or heavy work will not impact an early pregnancy. There are a lot of changes that need to occur with the cells and genes in a developing pregnancy, and sometimes those changes do not happen perfectly. There are some health conditions or habits that can increase the chance that an early miscarriage will occur, including:
- Heavy smoking
- Use of illicit drugs, especially cocaine
- Poorly controlled diabetes
- Hyperthyroidism or hypothyroidism
- Physical problems with the uterus, including fibroids or abnormalities of development of the uterus
Treatment of early miscarriage
Not all miscarriages “need” treatment. The choice of whether to wait for the pregnancy to completely pass without any treatment is up to you. Our doctors are committed to providing options for all patients, including the pros and cons of all available options when miscarriage is diagnosed. All patients with Rh-negative blood, regardless of which option they choose, need treatment with Rh-immune globulin, an injection that prevents a woman from forming substances in her blood that may attack the baby during a future pregnancy.
When a diagnosis of miscarriage is made, options include:
- Expectant management: This means that you will not receive any treatment; just continued follow-up. In an early miscarriage, with time, most women will pass the pregnancy completely. The main issue is time—there is no way to predict exactly when this will occur. You will typically have heavy bleeding and severe abdominal cramping when the pregnancy does pass. Should you want this option, our doctors can review exactly what to expect, how much bleeding is too much bleeding, and what pain medications can be used once the pregnancy begins to pass from the uterus.
- Medical management: This treatment uses medicines to cause the pregnancy tissue to pass from the uterus. The medicines cause cramping and bleeding, just like what will occur with natural passing of the pregnancy tissue. Using the medicines is like expectant management, except that you know when the pregnancy is going to pass. Most women will pass the pregnancy within 24 hours of taking the medication. Similar to expectant management, our doctors can review exactly what to expect, how much bleeding is too much bleeding, and what pain medications to use during treatment. If the pregnancy does not pass, you can repeat the medical treatment, have a suction aspiration, or continue to wait.
- Suction aspiration: this brief procedure can be done in the office or the operating room. The following steps occur regardless of the location:
- The woman is in the same position as during a regular pelvic exam, like when a Pap test is done.
- A speculum is placed in the vagina
- A cleansing antibacterial solution is applied to the cervix and vagina
- Numbing medicine is applied to the cervix to decrease cramping
- The cervix is dilated (opened) with thin rods; with early miscarriage, the cervix does not need to be opened much to complete the procedure
- A thin straw-like tube is placed through the open cervixThe pregnancy is removed using a mechanical suction pump attached to the tube
- Everything is removed from the vagina when the procedure is done
You may choose to have the procedure in the office or operating room based on your preferences-- different women have different needs.
- A spouse, partner, friend or relative can be in the room with you
- If desired, oral medications can be taken before the procedure to help you feel more relaxed
- You can eat or drink anything you want before the procedure
- The suction used in the office is most commonly a syringe that creates the suction so no noisy machine is used
- You will usually goes home 15-30 minutes after the procedure and can resume relatively normal activities
- Operating room procedure
- The procedure is done in an outpatient operating suite or in the main hospital
- You will be asleep during the procedure
- You cannot eat or drink anything after midnight on the night before the procedure because you will be receiving anesthesia
- You will feel sleepy for the whole day after the procedure and will need someone to be able to drive you home and be with you for the whole day after the procedure
- The operating room is more appropriate for women with certain medical conditions
Bleeding may continue for several weeks after a miscarriage but tends to be much lighter with a suction aspiration. Any bleeding may change in color from bright red to pink or brown. Lower abdominal cramping in the few days after treatment is also common. You should contact a doctor right away if the bleeding gets heavier after the miscarriage instead of lighter, if a fever develops, or if vaginal discharge or a strange or unpleasant vaginal odor occurs. Avoid intercourse, douching, or using tampons for one week. Regular activities can be resumed right away, based on how you feel. Importantly, if you want to delay getting pregnant after the miscarriage, it will be very important to start an effective method of contraception.
Frequently Asked Questions
Q: Does having a miscarriage mean I'm more likely to have another one?
A: Having one miscarriage does not increase your chances of having another. If you have had only one prior miscarriage, the rate of miscarriage in the next pregnancy is similar to the overall rate in the general population.
Q: Can being too active cause a miscarriage?
A: No. Working, exercise, and sexual activity do not increase the risk of miscarriage.
Q: After my miscarriage, how long should I wait before I try to conceive again?
A: Patients were told years ago to wait one or two menstrual cycles to wait to get pregnant. We know that it is highly unlikely that any problems occur with a next pregnancy if you get pregnant right away. How soon you decide to try again will depend on whether you want to be pregnant right away and if you feel you need time to recover emotionally from the miscarriage. Ovulation can resume as early as two weeks after a miscarriage, so if you do not want to get pregnant right away, you need effective contraception immediately.
Q: I have had two early miscarriages. Should I have special testing?
A: Since most early miscarriages are caused by problems specific to that fertilized egg, and miscarriage overall is relatively common, most experts do not recommend special testing until you have had three early miscarriages (or two miscarriages in women 40 years and older). At that point it is termed "recurrent" miscarriage and further testing may be needed. Studies have shown that even after a woman has experienced three consecutive miscarriages, her chance of the next pregnancy being normal is still about 70%. All women who have a pregnancy loss later in pregnancy should have further testing.