Miscarriage – Types, Causes & Symptoms

Of the many apprehensions that a pregnant woman faces, the most common is the fear of miscarriage. While a miscarriage is a sign of immediate medical attention in many situations, adequate care can prevent its occurrence. Being informed about the various factors which affect the health of the foetus especially during the early stages of pregnancy can help protect against a miscarriage.

What is a Miscarriage?

According to sources, miscarriage or spontaneous abortion is the most common type of foetus loss during pregnancy. It is the natural death of the embryo before it is able to survive independently. Miscarriage in pregnancy is sadly very common in women during the first few months of pregnancy and is known as first-trimester miscarriage. The first pregnancy miscarriage rate is said to be high as well, which is why maximum care needs to be taken especially during the initial stages of pregnancy. According to Healthline, around 10 to 25% of all pregnancies result in miscarriage.

Cases are often mistaken, due to the onset of a late period, as an uninvited pregnancy. Although miscarriage in pregnancy is common, it can still be a devastating and traumatic experience for everyone involved.

Pregnancy and Miscarriage

A miscarriage usually occurs before the foetus is 24 weeks old. A foetal loss experienced in the first 12 weeks of pregnancy is commonly known as early miscarriage, while a foetal loss occurring between 12-24 weeks is known as late miscarriage.

1. How does a Miscarriage Start?

Most of the miscarriages are due to genetic abnormality. But a point of relief is that these abnormalities are not genetic; in the sense that these occurrences are not passed down to the next pregnancy. Certain uterine abnormalities can also lead to miscarriages. Even thyroid disorders can result in miscarriages, even though they have a low percentage. A weak cervix or an incompetent cervix can cause miscarriage usually in the second trimester.

2. Reasons for Miscarriage

There could be various reasons for miscarriages to happen and a few among them could be due to an individual’s habits. According to the American Pregnancy Association, habits such as drugs, alcohol consumption and smoking can play a role. Scientifically speaking, certain bacteria majorly found in eggs and raw meats get embedded in the system and cause miscarriages. Psychologically speaking, maternal trauma could also lead to the unfortunate incidents. A few others include hormonal abnormalities, chronic illness and delayed pregnancy.

3. What happens when you have a Miscarriage?

It is normal for a woman who faces miscarriage to undergo immense mental trauma as the situation is hard to let go. For a certain period of time, the depression might take a toll on you, and it is during this time when emotional support is needed more than ever. Also, miscarriage develops a fear of pregnancy in some women, wherein they are presumably reluctant to attempt for the next pregnancy. It is hard and sorrowful, but eventually, things will be alright with time.

4. Can one have a Miscarriage and not be Aware of it?

Sometimes, the bleeding and cramps are mistaken as a potential miscarriage. But during these incidents, one has to be extremely careful to strike any possibility of miscarriage, if at all it exists. Only an ultrasound can confirm a miscarriage and hence in any situation of cramps accompanied with bleeding one needs to see a doctor to confirm and not take it lightly. One might have overlooked a possibility of an early miscarriage bleeding.

5. Does a Miscarriage Cause Pain?

One might observe mild to severe cramps and mild back pain in certain situations.

6. How common is a Miscarriage?

Every one in four recognised pregnancies has a high potential of facing a miscarriage. Nearly 85% of miscarriages happen in the first trimester of the pregnancy. A woman under 30 has a 1 in 10 chances of miscarriage and this frequency increases as the age increases.

Early Symptoms of Miscarriage

A miscarriage in the early weeks can often be mistaken for being a late or normal period. In such cases, the woman shows symptoms common to that of a period such as spotting or bleeding, backaches and mild cramps. These symptoms can soon progress to a full-fledged period bleed, accompanied by severe cramps and blood clots. If you are well into your pregnancy cycle, you may also go into a phase of early labour. Bleeding or having uncertain pains during any stage of your pregnancy is alarming and should be checked with a general physician as soon as possible.

In some cases of miscarriage in pregnancy, the woman may not experience any pain or bleeding and may completely be oblivious to the fact that she has experienced a foetal loss. It is only during a routine scan that the foetal loss is acknowledged. This is called a silent miscarriage or a missed miscarriage.

Causes of an Early Pregnancy Loss?

The most common cause of miscarriage in pregnancy can be due to a problem with the chromosomes which might restrict the foetus from developing totally. Apart from a genetic abnormality, certain other factors play a role in causing a miscarriage in pregnancy. These include:

• Abnormal Levels of Hormones: While the secretion of pregnancy hormones is crucial for the growth and development of the foetus, abnormal levels of hormones can cause a miscarriage.
• Diabetes: Uncontrolled diabetes also heightens the chances of a miscarriage.
• Proximity to hazardous materials: Exposure to workplace hazards, chemicals, environmental radiation and toxic substances.
• Certain medication like painkillers(Ibuprofen, naproxen etc.).
• Excessive smoking and alcohol consumption during pregnancy.
• Illegal drug usage and Uterine abnormalities like a uterine septum. While some abnormalities are from birth and others are developed during adulthood.
• Some of the antibodies protect us while some other are harmful which is why factors as such affecting the immune system can cause miscarriage.

Different Types of Miscarriage

Different types of miscarriages occur based on either the condition of the foetus or the woman’s body.

Chemical Pregnancy

In the case of a Chemical Pregnancy, the egg gets fertilised but is never implanted in the uterus. This gives the body a false signal resulting in the creation of pregnancy hormones which may lead to a positive pregnancy test, three to four days prior to the woman having her period. Because the egg is not implanted, there will be no sign of pregnancy, as there will be no gestation or placenta present. In such a case, the pregnancy is termed to be not viable clinically. Some other signs include menstrual cramps and bleeding within days of getting a positive pregnancy result.

Missed Miscarriage

A missed miscarriage occurs when the miscarriage is acknowledged via clinical examination such as an ultrasound test, but the woman has not complained of any miscarriage signs or symptoms. Such a miscarriage is also known as silent miscarriage.

Blighted Ovum

In blighted ovum, the foetus is not fully developed and gets absorbed by the uterus instead. The woman will, in such situations, experience pregnancy symptoms and will also form a gestational sac, but the baby will not develop.

Incomplete Miscarriage

In some cases, the uterus holds some tissues inside, which will lead to more cramping and bleeding as the uterus tries to expel the remaining tissues to empty the uterus. The doctor may perform a surgical procedure to empty the uterus of any pregnancy tissues.

Complete Miscarriage

A complete miscarriage occurs when the uterus has successfully emptied itself of all the remaining contents. Bleeding and cramps  may continue because the uterus contracts and lets the blood flow out.

Recurrent Miscarriage

Only a small population of women experience repeated miscarriages throughout their pregnancy. are not too common and are attributed to uterine and cervical conditions apart from chromosomal disorders.

Ectopic Pregnancy

is a condition where the embryo usually implants itself other than inside of the uterus. Such an embryo cannot survive and will lead to a miscarriage. In such cases, the mother-to-be may experience some form of vaginal bleeding and severe pain in the lower abdomen.

Molar Pregnancy

In a , the tissue which is supposed to become a foetus, becomes an abnormal growth in the uterus instead. It has to be surgically to make sure all the tissues are removed.

Treatments for Miscarriage

There is no sure shot treatment for miscarriage. However, the doctor may advise you to take complete rest and/or surgically remove any remaining foetal tissue inside your uterus.

Risks Involved in a Miscarriage?

While miscarriage is an unfortunate event, the amount of danger it poses depends on the number of months since the woman has conceived. 15% of almost all pregnancies end in miscarriages and occur within the first 20 weeks of pregnancy.

However, if it occurs later on (between 5-8 months), it can be dangerous and cause complications like haemorrhaging, infertility and in extreme cases, death. However, regular check-ups will help you stay calm and figure out whether you are at risk of going through a miscarriage early on.

Chances of Miscarriage

First trimester miscarriage is a major concern as the foetus is not yet developed enough to survive. Here is a depiction of the chance of miscarriage week-by-week:

Week 0-6	75%
Week 7-12	5%
Week 13-20	3%
Beyond 20 weeks	N/A

Chances of Miscarriage by Age

According to Advanced Fertility Center of Chicago, women between the ages of 44-46 years are at the highest risk of pregnancy loss, estimated to be as high as 60%. The lowest pregnancy losses have been reported at 8%, for women below the age of 30 years. The chances of having a miscarriage are thus lower in younger women than in older women.

Here is a tabular representation of the chances of miscarriage by the age of the mother:

<30	8%
30-40	12%
35-37	16%
38-39	22%
40-41	33%
42-43	45%
44-46	60%

How Many Pregnancies End in a Miscarriage?

About 15-20% of recognised pregnancies end up in a miscarriage. Most of the recognised miscarriages occur in the first trimester of the pregnancy or in some cases, there are chances of a second trimester miscarriage. The probability to have a miscarriage increases with increasing age of the woman.

Post-Miscarriage Care

There is a list of things one must follow for recovery after miscarriage. Give yourself time to heal physically and emotionally. You might bleed for some days, and it could be painful and depressing. You are also suggested to check your body temperature for the next few days or a week as the mental trauma, and physical loss of stamina can take a toll on you and make you fall sick. Avoid any sexual intercourse for the next few days and try to relax yourself and your body to give it some time to heal. Also, try and wear sanitary pads for the next one or two days to avoid any impromptu blood flow due to miscarriage.

Can Miscarriage be Prevented?

Even after you have detected the miscarriage, it is hardly possible to prevent it. Making sure that your abdomen is safe and taken good care of is vital, and one must ensure this timely. Make it a rule to check your medication in any scenario and ensure it is from an authorised source.

How is Miscarriage Diagnosed?

After the symptoms are confirmed, the doctors run a series of tests. The most important among them is HCG blood test. Some other measures in the purview of a doctor are a pelvic exam, foetal heart scanning and ultrasound. In an ultrasound, there are certain factors taken into consideration like lack of development of gestational sac, lack of foetal heartbeat, an embryo not having a heartbeat when larger than 5mm in size.

In the earlier stages, transvaginal ultrasound is preferred, and in the later stages, extra abdominal ultrasound is preferred. One must not forget that an ultrasound can yield results in favour or not of a safe and positive pregnancy. Doctors will use a foetal heart monitor in the latter part of the trimester to detect a miscarriage if at all it exists. In the early stages of pregnancy, a skip of the heartbeat may not suggest a miscarriage. A pelvic exam is conducted for checking a dilating cervix which is a strong indication of a miscarriage.

Trying to Conceive After a Miscarriage

While it can be very hard and sometimes traumatic to try to conceive after a failed pregnancy, there is always hope. A miscarriage does not mean that you have no chances of becoming pregnant again. If you feel that you are ready to try again, you should go ahead with your decision. Getting pregnant after miscarriage is possible, and you and your partner must talk about it before taking a decision.

1. Pregnancy after a Miscarriage

One of the biggest questions for all mothers is – Can I get pregnant after a miscarriage? Doctors may suggest waiting for a while before trying to get pregnant although there isn’t any hard and fast rule to adhere to it strictly.

However these decisions are completely personal and may be based upon the mental condition of the woman and many other emotional and psychological factors like family support and resources and will to try again so early. One miscarriage does not mean that the next one will end up with the same fate. Visit a doctor and evaluate your choices and if you feel confident, you can try conceiving again. A doctor will be your best guide in such situations and even the only one guide in case you have faced more than two miscarriages. In such severe conditions, a doctor’s consultation must be adhered to.

2. How soon after a Miscarriage can you get Pregnant?

You can conceive within 2 weeks of a miscarriage if you are ready, but statistics have shown that conceiving within 6 months gives you a higher chance of having a positive and successful pregnancy again. You can also consult your doctor if you feel there are medical complications that may arise.

Are there any Chances of Having a Miscarriage Again?

According to American Pregnancy Association, 85% of women who have faced miscarriage for the first time tend to have a safe and healthy pregnancy the second time. It is generally a one-time thing and only a very small percentage of women tend to have two or more consecutive miscarriages. According to reports, the chances of having a miscarriage the second time after having one is less, and only 14 percent of such incidents are reported as of now.

Any bleeding during the course of your pregnancy is a cause for concern. If bleeding occurs, the doctor will perform a pelvic exam and an ultrasound to confirm that miscarriage. During the tests, if the uterus is seen to be free from any foetal tissues, or if it is still an early pregnancy, no further treatment will be required. However, in case the foetus or other tissue is still present it needs to be removed, either surgically or by medication.

The process of removing the traces of a miscarriage are performed under anaesthesia will give way to miscarriage side effects such as bleeding and cramps. If the baby has died at a later stage of the pregnancy, the doctor will induce forced labour and cause delivery. After the delivery the doctor will examine the baby and the placenta to rule out the causes of death of the baby.

Miscarriage can be a tough hurdle to cross especially for couples who are actively trying to start a family. However, it is important to understand that sometimes it is the only way out of an unviable pregnancy. Receiving adequate care, consulting the doctor to understand the possible causes, and taking a breaking before trying to conceive again is sure to help in making the next pregnancy a successful one. e. The emotional support on the part of the family is crucial and plays a deciding role in such situations. It is highly suggestible to take a break before trying for the next pregnancy and give oneself some time to grasp the facts and decide accordingly.