What To Do When Miscarriage
Strikes (From the PDR Family Guide to Women's Health
Miscarriage can leave a couple
severely shaken as the anticipation of having
a baby suddenly turns to grief over a loss.
Many feel devastated and guilty even if the
miscarriage occurs during the early weeks or
months of the pregnancy. However, while it's
normal to blame some specific act or situation,
miscarriages are rarely triggered by factors
under the partners' control.
Exercising, a minor fall, or
sexual intercourse does not typically cause
a miscarriage. The fetus is well protected
by the mother's bones and muscle as well as
by the amniotic fluid in which it floats. There
is also no evidence that conceiving while taking
birth control pills increases the risk of miscarriage.
Becoming pregnant while using an IUD, however,
does make you more likely to miscarry or develop
As many as 30 percent of all
pregnancies end in miscarriage, half of them
before the woman even realizes she is pregnant.
Fortunately, most women who miscarry, even
more than once, can become pregnant again and
give birth to a healthy baby. If you have had
a miscarriage and want to try again, work with
your doctor to learn the reason for the loss
and to plan future pregnancies. Closely monitored
pregnancies are especially important for women
who have miscarried.
Your doctor may refer to a miscarriage
as a “spontaneous abortion,” since
“abortion” is the medical term
for any interrupted pregnancy. A miscarriage,
or spontaneous abortion, is the loss of a pregnancy
before the fetus can survive outside the womb,
usually within the first 20 weeks.
Any bleeding from the vagina during pregnancy
suggests the possibility of miscarriage. Call
your doctor about any abnormal vaginal bleeding,
even if you do not think you are pregnant.
Bleeding or spotting may be the first sign
that you are pregnant and that the pregnancy
is at risk. Staining or bleeding does not necessarily
mean that you will miscarry, however. About
20 to 25 percent of pregnant women have some
spotting or bleeding early in pregnancy, and
about half of these pregnancies continue successfully.
Bleeding that signals possible
miscarriage is usually light. It can be brown
or bright red and may occur repeatedly over
many days. If the bleeding persists or increases,
the chances of losing the baby are higher.
Mild pain, such as cramping or low backache,
usually develops at some point after the bleeding
has started. Some women experience severe abdominal
pain and dizziness.
If you have been bleeding and
an ultrasound scan (sonogram) indicates that
the fetus is alive, your doctor probably will
ask you to rest in bed as much as possible.
Avoid sexual activity. The doctor will monitor
you to be sure that bleeding and cramping remain
mild, that the cervical canal from the uterus
stays closed in order to retain the baby in
the uterus, that sonograms continue to show
fetal heart movements, and that the fetus is
growing. More than 90 percent of firsttrimester
pregnancies continue when ultrasound scans
indicate that the baby is alive.
Rarely, early in pregnancy, fluid
is suddenly released from the vagina without
bleeding or pain. If you experience this, call
your doctor immediately. You will probably
be instructed to stay in bed and watch for
further leakage, bleeding, cramping, or fever.
If, after a few days, you have none of these
things, your doctor may tell you that it is
safe to go back to daily activities. Avoid
intercourse and any other vaginal penetration.
If you do develop bleeding, pain, or fever,
however, miscarriage may be inevitable.
Types of Miscarriage
Miscarriages differ according to 2 main factors:
how far the pregnancy has progressed and how
much of the fetus and other elements of pregnancy,
such as the placenta, have been expelled from
the body. To prevent infection, it's important
to ensure that all material related to pregnancy
has been either expelled naturally or removed
from the uterus.
When bleeding and pain are accompanied by the
breaking of membranes (the amniotic sac surrounding
the fetus) and the widening of the cervix,
the pregnancy is viewed as lost (inevitable
miscarriage). Uterine contractions to expel
the fetus usually begin soon after these symptoms
Incomplete and Missed Miscarriages
In some miscarriages, the body does not expel
all the elements of pregnancy. This is called
an incomplete miscarriage. At other times—in
about 1 percent of pregnancies—the body
does not discharge the fetus, the placenta,
or any other elements of the pregnancy for
several weeks, even though the fetus has died.
This is known as a missed miscarriage. It is
a possibility when a woman has neither menstrual
periods nor any signs of pregnancy. Breasts
may return to their prepregnancy state, for
example, or the woman may lose a few pounds.
Not all missed miscarriages are preceded by
An incomplete or missed miscarriage
that takes place early in pregnancy is usually
removed with either suction or dilation and
curettage (D&C), “opening”
the uterus and scraping out its contents, through
the vagina, with an instrument called a curette.
These procedures not only clear the uterus
but also prevent infection. When incomplete
miscarriage occurs later in pregnancy, the
doctor may have to induce labor to remove the
Causes of Miscarriage
In general, miscarriage is more common in women
over 35 years old and in pregnancies involving
more than one fetus. In some multiple pregnancies
(twins, triplets, or more), one or more of
the fetuses survives even after another one
dies. The dead fetus leaves the mother's body
when the surviving baby is born.
Some of the factors discussed
in this section are more common after repeated—that
is, 3 or more—miscarriages. About 1 in
200 women has repeated miscarriages, which
physicians call recurrent spontaneous abortion.
In many cases—perhaps most—even
these miscarriages happen by chance and do
not signal a problem in either or both partners.
Often no cause is found.
Problems in the chromosomes of the embryo,
by far the most common reason for loss of pregnancy,
are found in more than half of miscarriages
occurring in the first 13 weeks. Miscarriages
apparently eliminate about 95 percent of fertilized
eggs or embryos with genetic problems—perhaps
nature's way of ending a pregnancy in which
the child would be unable to survive. Spontaneous
abortions of this type usually occur before
the woman knows that she is pregnant. Most
chromosomal problems happen by chance, have
nothing to do with the parents, and are unlikely
Sometimes, however, chromosomal
abnormalities are caused by the parents' genes.
This is more likely if the woman has had repeated
miscarriages or if either parent has relatives
or a child with birth defects. Genetic testing
and analysis of fetal material from the miscarriage
can help the doctor identify the problem.
Miscarriages are much less common in the third
trimester. Those that occur are more likely
to be due to maternal factors, such as an illness
in the mother, than to genetic abnormalities
in the baby.
Women with poorly controlled
diabetes are at great risk for miscarriage.
Those whose diabetes is controlled, however,
whether it existed before the pregnancy or
developed after conception (gestational diabetes),
are no more likely to lose a pregnancy than
other women. A woman may not know that she
has diabetes, however, until it is discovered
during a search for the cause of repeated miscarriages.
The routine blood and urine tests given during
pregnancy are an effort to identify this problem
while it still can be remedied.
Other diseases and conditions
linked to increased risk of miscarriage include
systemic lupus erythematosus (SLE, or lupus),
high blood pressure, and certain infections,
such as rubella (German measles), herpes simplex,
and chlamydia. Experts disagree about the role
of hypothyroidism, or an underactive thyroid
gland, in miscarriage, but it's likely that
a severe case increases the risk.
With conditions such as diabetes,
treating or controlling the problem can improve
the odds of a successful pregnancy. Special
monitoring may also be required.
Some women do not make enough progesterone,
the hormone that prepares the lining of the
uterus to nourish a fertilized egg; and if
the uterine lining cannot sustain an egg, miscarriage
will occur. Progesterone supplements, given
by injection or in vaginal or rectal suppositories,
can correct this problem. The medication also
can make it more difficult for a dead fetus
to be expelled. A blood test and a biopsy of
a small amount of tissue taken from the uterine
lining can determine whether you are producing
enough progesterone naturally. Hormone imbalance
also can be caused by diabetes mellitus or
Abnormalities of the Uterus
Anything physically wrong with the uterus or
cervix can lead to a miscarriage. Some defects
may be present from birth. Fibroids—noncancerous
growths made of uterine muscle tissue—can
also be at fault. So can a weak cervix that
widens too early in pregnancy without any warning
signs of labor, releasing the fetus from the
These physical problems account
for up to 15 percent of repeated miscarriages.
To diagnose such problems, the doctor may inject
the cavity of the uterus with some fluid, then
take an xray of your uterus and fallopian
tubes. Another technique is to examine the
inside of your uterus through a long, thin
instrument (hysteroscope) inserted through
the vagina and cervix. In another procedure,
the doctor may make a small incision in the
lower abdomen and insert a laparoscope, through
which he or she can inspect the pelvic organs.
Surgery can correct many abnormalities in the
uterus but your doctor probably won't recommend
it until all other causes of miscarriage have
been ruled out. After surgery, 70 to 90 percent
of pregnancies are successful.
Though a weak cervix is a relatively
rare condition, it's almost impossible to detect
before it becomes apparent during pregnancy,
usually after the 15th week. Once discovered,
it is likely to disrupt every pregnancy. To
remedy the problem, after the first trimester,
but before the cervix has dilated (widened)
to a certain point, your doctor can reinforce
the cervix with sutures, which will be removed
when the baby reaches term. Women with bleeding,
uterine contractions, or ruptured membranes
should not undergo this procedure.
Immune System Problems
A developing baby is half made up of foreign
genetic material from the father. Some women
have repeated miscarriages because their bodies
see each baby as an invading organism and attack
it with antibodies. Ordinarily, many elements
of the immune system work together to ensure
that the mother's body does not reject the
baby. But when this coordination fails, a miscarriage
follows. Treatments for such problems in the
immune system are experimental and should not
be tried until other causes for repeated miscarriage
have been ruled out. Some research centers
have tried to “immunize” the mother
with the father's white blood cells, but so
far without good results.
Certain autoimmune diseases and
abnormalities also increase the risk of miscarriage.
Women whose blood contains certain types of
antibodies are at particularly high risk. These
women may have no symptoms other than trouble
retaining a pregnancy, but a blood test can
determine whether the antibodies are present.
If so, heparin, prednisone, and aspirin during
pregnancy can help prevent miscarriage. About
70 to 75 percent of women with lupus-associated
antibodies who are treated with these drugs
are able to deliver. In any case, if you have
these blood abnormalities, you should have
your doctor watch you closely. The baby may
grow too slowly or develop other complications.
Minimizing the Risk of Miscarriage
Most miscarriages are caused by chromosomal
(genetic) abnormalities and other physical
factors that are beyond your control. There
are, however, steps you can take to reduce
the risk of losing a pregnancy.
Don't smoke. Smoking increases
the risk of losing a genetically normal baby.
One study showed that women who smoked more
than 14 cigarettes a day were about twice as
likely to miscarry, regardless of their age
or use of alcoholic beverages. The risk of
losing a pregnancy increases with the number
of cigarettes a woman smokes. On the other
hand, giving up smoking at any time during
the pregnancy will benefit the baby. Since
passive smoke is also dangerous, it's wisest
if no one in your household smokes during the
Don't drink alcoholic beverages
or much caffeine. Having an alcoholic drink
twice weekly doubled the risk of losing normal
babies in one study; drinking alcohol every
day tripled the risk of such miscarriages.
Similarly, consuming large amounts of caffeine—more
than 4 cups of coffee per day (or the equivalent
in other substances that contain caffeine)
slightly increases the chance of miscarriage.
The risk appears to rise with the amount of
caffeine consumed; and doctors generally recommend
limiting intake to one cup of coffee per day.
Avoid radiation and poisons.
Exposure to high levels of radiation or toxic
substances increases the risk of miscarriage.
The dangers of various levels of radiation
are discussed in the chapter on “Strategies
for a Healthy Pregnancy.” Arsenic, lead,
formaldehyde, benzene, and ethylene oxide can
cause miscarriage. Make sure you are not exposed
to these substances at work or anywhere else
while pregnant or trying to conceive.
Prevent trauma to the abdomen.
Don't participate in sports such a skiing that
might involve serious falls. Stab wounds or
injuries from the steering wheel or seat belt
in a car, especially during the second trimester,
sometimes cause miscarriage. See the nearby
box for the right way to wear a seat belt when
you are visibly pregnant.
Check out all medications
with your doctor. Certain prescription
and overthecounter drugs are associated
with fetal abnormalities and miscarriages.
Consult your doctor before taking any medication
when you are pregnant or trying to conceive.
Some drugs can damage the fetus and cause miscarriage
before you even know you are pregnant.
Miscarriages due to random natural factors
are so common that they are not considered
medically significant until you've had 3 in
a row. At that point, the problem is officially
classified as “recurrent miscarriage,”
and your doctor will recommend a complete diagnostic
The investigation will probably
start with a detailed interview. Which tests
are performed will depend on your own personal
and medical history, the father's history,
and how many miscarriages you have had. You
will be tested for infections of various kinds,
possibly including sexually transmitted diseases.
Blood tests may be done for hormonal problems
or a malfunction in the immune system. You
and your partner may be tested for chromosomal
abnormalities and genetic diseases as well.
The lining of your uterus may be analyzed from
a small sample. The doctor may order xrays
of your uterus and fallopian tubes to look
for a blockage, fibroid, or scar tissue.
Knowing as much as possible about
why the miscarriages are happening can increase
the chances of having a normal pregnancy in
the future. It's best to postpone trying to
conceive again until your medical evaluation
is complete. More than likely, you can carry
a baby to term. Unless the problem involves
autoimmune antibodies, chromosomal abnormalities,
or a weak cervix, there's a 70 to 85 percent
chance of success, even after 3 miscarriages.
Allow yourselves to grieve after losing a pregnancy.
Many couples feel a renewed sense of emptiness
and loss at the time the baby would have been
born. Consider joining a selfhelp group
such as one of those listed at the end of this
book. Your obstetrician or local hospital may
be able to suggest others. Try not to blame
yourself. Instead, concentrate on finding out
what went wrong—and how you can make
Some couples want to conceive
again quickly. While such a step may be physically
possible, it is psychologically unwise. Nevertheless,
sex can be resumed safely within 2 to 4 weeks
after miscarriage. A woman's body usually is
prepared for another pregnancy after 1 or 2
normal menstrual periods. Ovulation can occur
as little as 2 weeks after a miscarriage.
Give yourselves enough time to
recover emotionally from your loss before facing
the challenges of another pregnancy. As with
any major life event, it's important to balance
the need to grieve with the need to move on.
And remember, most couples who experience a
miscarriage can go on to have a healthy baby.