What is early miscarriage?
miscarriage is the loss of a pregnancy in the first 12 weeks (NICE 2013).
How common is early miscarriage?
Sadly, early miscarriages are very common. It’s perfectly possible to have a miscarriage
before you even realise you’re pregnant. About half of all fertilised eggs are thought to be lost in the earliest days of pregnancy, before a pregnancy test has been done (Jurkovic et al 2013, NICE 2013).
a positive pregnancy test, between 10 per cent and 20 per cent of pregnancies end in miscarriage (Jurkovic et al 2013, NICE 2012, NICE 2013, RCOG 2012). Most miscarriages happen in the first 12 weeks of pregnancy
Miscarriage at any stage of pregnancy can be a terrible blow. Even if it happens very early on in pregnancy, it’s only natural that it comes as a shock. Don’t feel you’re not allowed to grieve over your loss.
What causes early miscarriage?
Early miscarriages usually happen because the embryo is not developing as it should (NICE 2013). Chromosome
problems are thought to be the most common cause (Jurkovic et al 2013, RCOG 2016). These problems usually happen for no reason and are unlikely to happen again.
To develop properly, a baby needs the right number of
normal chromosomes. He’ll need 23 from his mum and 23 from his dad. Chromosomal abnormalities can prevent a baby from developing. These abnormalities may happen because there are too many chromosomes or not enough chromosomes, or because there are changes
to a chromosome’s structure. In that case, the pregnancy will come to an end at the embryo stage.
It’s thought that up to 95 per cent of pregnancies with chromosomal abnormalities end in miscarriage (NICE 2013).
How do I know if I’m having an early miscarriage?
The most common signs and symptoms of miscarriage are vaginal bleeding
and strong period-type cramps (MA 2015, NHS 2015).
The bleeding can vary from light to heavy, perhaps with blood clots, and may come and go for a few days (NICE 2013).
symptoms settle down and the pregnancy usually carries on. This is called a threatened miscarriage (NICE 2012). There is some, limited evidence that treatment with progesterone may stop a threatened miscarriage from happening.
Progesterone is not offered as a routine NHS treatment, but it may be worth asking your doctor about it (Jurkovic et al 2013).
Unfortunately, though, if a miscarriage is really under way, it will usually take its course (Jurkovic et al 2013, NICE 2012).
With any bleeding or pain in early pregnancy, call your doctor, or your hospital’s early pregnancy unit (EPU) or out-of-hours service (NICE 2012). You’ll
find more advice and support in our article about what to do if you think you’re having a miscarriage.
early miscarriages are discovered only during a routine pregnancy scan. A scan reveals an empty pregnancy sac, where the embryo should be. This is called a
missed or silent miscarriage (Crafter and Brewster 2014, NICE 2013, MA 2015).
You may have had no idea that you've had a missed miscarriage, in which case it will come as a terrible shock. Or you may have had some symptoms, giving you a growing fear that all was not well.
What will happen after the miscarriage?
In most cases, a woman’s body will complete the miscarriage naturally (Jurkovic et al 2013, NICE 2012, NHS 2015). If this happens to you, you won’t usually need further treatment.
The bleeding is likely
to tail off in a week to 10 days and will usually have stopped after two weeks or three weeks. You’ll be able to rest at home with painkillers and a hot water bottle, and, most important of all, someone to comfort and take care of you.
doctor may ask you to do a pregnancy test at home after your miscarriage, to confirm that the pregnancy has ended (MA 2015, NICE 2013).
Depending on your stage of pregnancy and whether you are still experiencing symptoms,
you should be offered a follow-up appointment two weeks after the miscarriage. This is to check that your body is recovering as it should.
You may be referred to an early pregnancy unit (EPU) if there’s one near you
(NHS 2015, Jurkovic et al 2013). There are more than 200 EPUs in the UK, so there’s a good chance you’ll have access to one.
At the EPU, you may be offered an ultrasound scan and other tests to confirm that the pregnancy has ended (MA 2015).
If the bleeding doesn’t tail off or stop
after two weeks or so (Jurkovic et al 2013, NICE 2012), you may need extra care from hospital doctors. The bleeding may mean there are some pregnancy tissues left in your womb (uterus). This is called an incomplete miscarriage
and may need treatment (MA 2015).
Your doctors are likely to advise one of the following approaches:
- Expectant management: the bleeding is given up to a week more to settle, without treatment,
as long as there’s no sign of infection (Jurkovic et al 2013).
- Medical management: your doctor will give you medicines to help along completion of the miscarriage (Jurkovic et al 2013).
- Surgical management: your doctor will perform a minor operation to complete the miscarriage. Doctors call this an SMM, which stands for surgical management of miscarriage (MA 2015).
With medical management,
you may be offered tablets to swallow or a pessary to insert into your vagina. The bleeding after medical management can be heavy and take longer to stop (NICE 2012). But it will mean you don’t have to have surgery, and
you should only have to stay in hospital for a short while after your treatment.
An SMM takes a few minutes and you’re likely to recover quickly. It’s most likely that your doctor will carry out the procedure while you’re asleep
under a general anaesthetic (Jurkovic et al 2013).
Some hospitals offer the option of surgical management with a local anaesthetic, instead of a general. This procedure is called MVA, which stands for manual vacuum
aspiration (MA 2015, NICE 2012).
One advantage of surgical management is that bleeding usually stops more quickly afterwards (Jurkovic et al 2013, NICE 2012), which may help to ease your
distress. It also means there is less chance you’ll have to go back into hospital for further treatment (NICE 2012, MA 2015).
SMM works very well and in most cases no further treatment is needed. Your doctor
is particularly likely to recommend SMM if you have heavy bleeding or signs of infection (NICE 2012).
Deciding whether or not to have treatment and which option to go for is a highly personal decision
(MA 2015, Nanda et al 2012). Most women prefer to let nature take its course, even if it means they may need treatment later (Jurkovic et al 2013). Others want the miscarriage to be over as soon as possible
(MA 2015, NICE 2012, Sands 2016).
Your doctor should explain all the options so that you have the information you need before you decide what to do (MA 2015, Nanda et al 2012, NICE 2012). Your chances of having
a healthy pregnancy next time round are equally good, whichever option you choose (Jurkovic et al 2013, Nanda et al 2012, NICE 2012, MA 2015).
Unless you need emergency treatment, your doctor should give you time to
make your choice (MA 2015, NICE 2012). To help you decide, your doctor will make it clear if she thinks one course of treatment is better for your health than another (NICE 2012).
may be surprised that your doctor doesn’t arrange for you to have any special tests after a first miscarriage. The sad fact is that early miscarriage is very common.
Serious medical problems aren’t usually to blame for an early miscarriage (NHS 2015). Most early miscarriages are one-off, so it is very likely that your next pregnancy will be a successful
one (NHS 2015). For this reason you’re unlikely to be given a follow-up appointment to see a consultant unless you’ve had three early miscarriages in a row (RCOG 2012).
I can’t seem to get over my miscarriage. Where can I get help?
Miscarriage can be traumatic because it takes away all the hopes and dreams that a positive pregnancy test brings. The experience can leave you with overwhelming feelings of loss and grief (Sands 2016).
Losing a baby can be tragic no matter how early in pregnancy it happens, and you will need to allow yourself a chance to recover and grieve.
In time, you will be able to look to the future again. When you’re ready to think about trying again, it may be some comfort
to know that most women go on to have a healthy baby in the future (NHS 2015, NICE 2012).
You may wish to contact the Miscarriage Association or counselling service at your local hospital for help. You may wish to have a memorial for your baby or write in a book of remembrance at your hospital. Some parents say that they found this helpful as a way of
saying goodbye to their baby.
Read stories from people who have been affected by
miscarriage and pregnancy complications over on Tommy’s website. You’ll also find plenty of support in BabyCentre’s community
from other families who have experienced loss.