How to Tell If You’re Having a Miscarriage

Miscarriage, known medically as a "spontaneous abortion," is an unexpected pregnancy loss within the first 20 weeks. Vaginal bleeding is a common symptom, though it does not necessarily mean that you are having a miscarriage. Other miscarriage symptoms include abdominal cramping, pelvic or back pain, nausea or diarrhea, or loss of pregnancy symptoms.

For those who know they are pregnant, the rate of miscarriage is between 10 and 25%. The rate of first-pregnancy miscarriage in the first trimester is about 18.5%. Rates could be higher as some people miscarry before knowing they are pregnant.

This article reviews possible causes of miscarriage, risk factors, symptoms, when to seek immediate medical care, types, treatment, resources, and how soon after miscarriage someone can get pregnant. 

What Can Cause a Miscarriage?

The leading cause of miscarriage is chromosomal abnormalities, making it impossible for the embryo (developing fetus) to grow. Chromosomal abnormalities account for up to 60% of first-trimester miscarriages. They are not the fault of either parent. 

While many miscarriages have no underlying cause, the following are possible maternal health concerns that could contribute to a miscarriage.

• Uterine anomalies (double uterus, Asherman syndrome, fibroids)
• Cervical incompetence (the cervix (opening to the uterus) opens too early)
• Imbalance of hormones, such as progesterone
• Immune system problems
• Ectopic pregnancy
• Rh incompatibility 

Risk Factors

Risk factors are circumstances that increase the risk of miscarriage. Risk factors do not cause miscarriage.

Additional miscarriage risk factors include the following:

• Advanced or paternal age 
• Previous miscarriage or ectopic pregnancy
• History of a cesarean surgery (c-section) 
• Fertility treatment
• Maternal health disorders (clotting disorders, thyroid disorders, kidney disease, uncontrolled diabetes, or polycystic ovary syndrome (PCOS))
• Infection in maternal reproductive organs (bacterial vaginosis, sexually transmitted infections (STIs), pelvic inflammatory disease (PID))
• ToRCH infections (toxoplasmosis, rubella, cytomegalovirus, and herpes simplex virus)
• Tobacco, recreational drug use, and alcohol use
• Exposure to environmental toxins (including radiation therapy)
• Obesity
• Severe malnutrition
• Group B strep infection
• Certain medications such as isotretinoin, acne treatment, and non-steroidal anti-inflammatory medications (NSAIDS)
• Pregnancy while using an intra-uterine device (IUD)
  

Paying Attention to Miscarriage Signs Within the Body

Vaginal bleeding is one of the most common signs of a possible miscarriage. However, this does not necessarily mean you are having a miscarriage, as 24% of pregnant people experience mild vaginal bleeding.

Abdominal cramping, in addition to vaginal bleeding, increases the possibility of a miscarriage. If there is no cramping along with vaginal bleeding, pregnancy continues successfully 50-75% of the time.

Additional symptoms of a miscarriage may include:

• Stomach upset (diarrhea, nausea) 
• Pelvic or back pain 
• Fluid coming from the vagina
• Passing tissue or clots 
• Weakness
• Loss of pregnancy symptoms 

Miscarriage Symptoms That Require Immediate Medical Care

While some dark red or brown spotting is common, the following symptoms could indicate a miscarriage and require immediate medical care:

• Bright red or large amounts of blood
• Fever
• Severe abdominal cramping, especially on one side of the belly. 

The healthcare provider may use the following methods to diagnose a miscarriage and rule out complications:

• Complete blood count (CBC): To check for infection or anemia.
• Vaginal exam: Checking for the source of bleeding and seeing if the cervix is open.
• Human chorionic gonadotropin (hCG) blood test: They will look at trends or changes in your numbers.
• Ultrasound: Checking for the baby's heartbeat and looking for signs of pregnancy.

The Type of Miscarriage Affects Treatment 

Early miscarriages do not typically require treatment. But, there are different types of miscarriage and medical management varies by type. 

Threatened Miscarriage

A threatened miscarriage is vaginal bleeding with a closed cervix. The pregnancy could continue, but there is a high risk of loss. Treatment involves bed rest, refraining from sexual intercourse, and, in some cases, hospitalization to prevent miscarriage.

Inevitable Miscarriage

An inevitable miscarriage is vaginal bleeding before 20 weeks with a dilated cervix. This indicates that miscarriage will happen, and there is no way to prevent the loss. Treatment involves close monitoring and possibly medical or surgical treatment to remove remaining pregnancy tissue that may not leave the uterus independently.

Incomplete Miscarriage

An incomplete miscarriage occurs when the body has not expelled all pregnancy tissue. Medical or surgical evacuation of the tissue may be necessary to prevent infection. 

Treatment may involve medications or surgery (or a combination) to remove the remaining tissue. These medications and surgical procedures may occur during miscarriage care or abortion care. Healthcare providers often follow this up with lab work and an ultrasound to confirm no pregnancy tissue remains in the uterus. 

Complete Miscarriage

A complete miscarriage is when your body passes all fetal tissue, and none remains. Treatment involves blood testing and ultrasound–to ensure that it was not incomplete–rest, and recovery.

Missed Miscarriage

A missed miscarriage is when fetal death occurs, but the tissue does not pass. If this happens during the first trimester, some healthcare providers may suggest waiting to see if the tissue will pass. 

If it occurs during the second trimester, you may require medication or surgery to help pass the tissue and avoid infection. Healthcare providers will take extra care to ensure the fetus is unviable through an ultrasound and blood tests before giving medications or performing surgery. 

Recurrent Miscarriage

A recurrent miscarriage is two or three consecutive miscarriages. While these may occur without cause, the healthcare provider may want to check for underlying causes with additional testing.

After Miscarriage: Support and Resources

Regardless of how far along the pregnancy was, a loss can cause various emotions. Whatever emotions you feel or how you grieve is ok and expected. But, while it may be natural to blame yourself, remember that most miscarriages are not because of something you did or didn’t do.

Don’t hesitate to seek support during this challenging time. Support groups can provide a safe place to grieve and share your story with others who have been through similar situations.

From Hurt to Healing is a free March of Dimes book for grieving parents. You can find similar resources and information about support groups from the following organizations:

• March of Dimes
• Centering Corporation
• Compassionate Friends
• Share Pregnancy and Infant Loss Support 
• International Stillbirth Alliance
• Miscarriage Association
• Sands 
• MISS Foundation
• The Center for Loss in Multiple Birth (CLIMB)
• Helping After Neonatal Death (HAND)

How Soon After Miscarriage Can You Get Pregnant?

Unless your healthcare provider tells you otherwise, you can start trying to get pregnant as soon as you are emotionally and physically ready. The majority of those who have a miscarriage can have a healthy pregnancy in the future. 

Most people have a period of four to six weeks after the miscarriage. You could get pregnant when you ovulate a couple of weeks before your next period. But, some healthcare providers suggest waiting to try until after you’ve had one period.

For those still having a miscarriage or recovering from surgery, wait a few weeks for sexual intercourse to avoid infection. If your healthcare provider is testing for possible underlying causes, waiting until they clear you is best.

Summary 

Miscarriage is the loss of pregnancy before the 20th week. The most common symptoms are bleeding and cramping. Causes include chromosomal abnormalities, hormonal imbalances, or maternal health issues. While a miscarriage can devastate the parents and families, many go on to have successful pregnancies in the future. It's important to seek support from healthcare professionals, loved ones, and support groups.