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Miscarriage
What is Miscarriage?
Miscarriage is the sudden loss of a pregnancy before the 20th week. Loss of pregnancy after this time is called a stillbirth. Miscarriages are far more common than most people realize. It is estimated that up to 20% of known pregnancies–one in five–end in miscarriage, and this number may be even higher when you consider that most miscarriages happen early on, before people realize they're pregnant. Many people don’t realize they have had a miscarriage.
Miscarriages happen for all kinds of reasons, usually because of developmental problems with the fetus that are nobody’s fault.
What are the symptoms?
Symptoms of miscarriage vary hugely from person to person, and cause different symptoms depending on the length of pregnancy, cause of miscarriage, other pre-existing health conditions, and an individual’s body.
It is possible to have a miscarriage without even realizing it. Early in a pregnancy, if a person does not know they are pregnant, miscarriages can be mistaken for heavy periods.
On the other hand, some miscarriages can cause painful, traumatic, and dangerous symptoms. It’s important to always see a doctor if you suspect you are having–or have had–a miscarriage.
Symptoms of a miscarriage may include:
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Bleeding from the vagina with or without pain. This can vary from light spotting or brownish discharge to heavy bleeding and bright-red blood or clots.However, light vaginal bleeding is relatively common during the first trimester (first 3 months) of pregnancy and does not necessarily mean you're having a miscarriage.
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Pain or cramping in the pelvic area or lower back
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Fluid or tissue passing from the vagina
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Fast heartbeat
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Ectopic Pregnancies
Sometimes, miscarriages happen because the pregnancy develops outside the womb. This is known as an ectopic pregnancy. Ectopic pregnancies are potentially serious as there's a risk you could experience internal bleeding.
Ectopic pregnancies occur when an embryo implants in one of the fallopian tubes instead of in the womb. This is catastrophic for both the embryo and the mother. There is no way an ectopic pregnancy can reach full term, as the fallopian tubes cannot accommodate a growing fetus. They will burst when the fetus grows too large for them to contain. This will lead to miscarriage, but also causes serious, potentially life-threatening damage to the mother. Ectopic pregnancies can be detected on scans, and it’s important to treat them quickly. There is no way to move an implanted embryo to the womb. The treatment for an ectopic pregnancy is abortion.
Symptoms of ectopic pregnancies include:
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Persistent and severe tummy pain, usually on one side
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Vaginal bleeding or spotting, commonly after the pain has started
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Pain in your shoulder tip
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Diarrhea and vomiting
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Feeling very faint and lightheaded, and possibly fainting
Symptoms of an ectopic pregnancy usually appear between weeks 5 and 14 of a pregnancy. If you experience any of these symptoms, go straight to an Emergency Room.
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How is it diagnosed?
A pregnancy care provider will perform an ultrasound test to confirm a miscarriage. These tests check for fetal heartbeat or the presence of a yolk sac (one of the first fetal structures a provider can see on ultrasound).
How is it treated?
It’s very important that, even if you no longer feel symptoms, you are treated for your miscarriage. If any fluid or tissue remains in the uterus, this can lead to serious infection and other complications. There are several ways that miscarriages are treated. ​
Expectant Management
If there are no symptoms of an infection, the miscarriage can progress naturally. This often occurs within a couple of weeks of finding that the embryo has died. It could take up to eight weeks to complete this process. Most often, expectant management is used in the first trimester. If the pregnancy tissue isn't passed from the body on its own, you'll need treatment with medicines or surgery.
Medical Treatment
This helps the uterus pass pregnancy tissue out of the body. Doctors may use a combination of the medicines mifepristone and misoprostol (which is more effective than misoprostol alone). Combined treatment has a higher rate of helping the body release all remaining pregnancy tissue. Mifepristone combined with misoprostol also provides a lower risk of needing surgery to complete treatment.
Surgical Treatment
A minor procedure called suction dilation and curettage (D&C) is another option for treating a miscarriage. During this procedure, your cervix is opened and tissue is removed from the inside of your uterus. The procedure is known as uterine aspiration. Complications are rare, but they might include damage to the connective tissue of the cervix or the wall of the uterus. You need surgical treatment if you have a miscarriage along with heavy bleeding or signs of an infection.
Counseling and Therapy
It’s normal to experience mental health challenges during and after a miscarriage. Your doctor should be able to refer you to therapists and groups in your area, and prescribe medications if necessary.
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Data, statistics, and research
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Miscarriages are common. Between 10% to 20% of known pregnancies end in miscarriage; that's one or two in every ten.
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An estimated 23 million miscarriages occur every year worldwide (44 pregnancy losses per minute)​
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Psychological consequences of a miscarriage include increases in the risk of anxiety, depression, post-traumatic stress disorder, and suicide
This graph communicates the most common week during pregnancy in which a miscarriage might take place.
Stanford Fertility and Pregnancy Loss Research,
directed by Dr. Ruth Lathi
Dr. Ruth Lathi is the Director of Research for Fertility and Reproductive Health and founder of the Stanford multispecialty Recurrent Pregnancy Loss program. Her work focusing on miscarriage and recurrent miscarriage has led to improved accuracy of chromosome testing of miscarriages, demonstrating a link between environmental exposures and miscarriage, elucidating the clinical utility of pre-implantation genetic testing of embryos, and understanding the impact of maternal weight on reproductive disorders
Case Studies
‘We suffer in silence’: five women share their miscarriage stories
A recent callout by The Guardian asked readers about having a miscarriage in the US and was answered by over 100 people.
Respondents described doctors who were coldly indifferent or made them feel like criminals; surprise at the realization that many around them had also gone through pregnancy loss; and callous reactions from people who didn’t understand the physical or emotional process of miscarriage.
‘I didn’t know what I was supposed to do’: US women who miscarry are in dangerous legal limbo post-Roe
In September 2023, when Doctors found that Brittany Watts' water had broken only 22 weeks into her pregnancy, they debated whether or not they could help her; given the Ohio abortion ban on the books. Meanwhile, within days, Watts miscarried into her home toilet.
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Police then charged Watts with the fifth-degree felony of “abuse of a corpse.” In January, months after an initial hearing and after news outlets across the country had covered the story, a Trumbull county grand jury declined to indict Watts, ending the harrowing possibility of a trial and even prison time.
What’s the difference between miscarriage and abortion? For some women, it’s hard to tell
There may be little distinction between the two, but lawmakers won’t listen and doctors are wary – and women pay the price.
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The gray area between miscarriage and abortion is newly worrying now that more than a dozen states criminalize abortion. Patients could find themselves facing legal repercussions or traveling hundreds of miles to seek miscarriage care, for fear of it being mislabeled as an abortion.
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