A miscarriage is both a common and devastating part of pregnancy. Between 10-20% of known pregnancies end in a miscarriage, not including miscarriages that occur before women are aware of a pregnancy. Still, no two pregnancy loss stories are the same. Knowing that it’s common doesn’t make it feel less isolating.
At The Ohio State University Wexner Medical Center in Columbus, Ohio, our obstetrics team provides you with sensitive and expert care to help guide you through the physical and emotional experience of a pregnancy loss. The vast majority of people go on to have perfectly healthy pregnancies after having a miscarriage, and we’ll be with you every step of the way following that loss.
What is a miscarriage and pregnancy loss?
A pregnancy loss at any time before 20 weeks of pregnancy is called a miscarriage. Most miscarriages occur in the first trimester, or before 13 weeks of pregnancy. This is called an early pregnancy loss. This can happen in the first few weeks after conception, often because the embryo doesn’t develop normally. The tissue can pass around the time of a period, so you may not even know you were pregnant.
Types of pregnancy loss
- Spontaneous miscarriage: Occurs when the embryo stops developing, and the body expels the pregnancy.
- Missed miscarriage: Occurs when the embryo stops developing but the body doesn’t immediately expel the pregnancy, often discovered during a routine ultrasound. You may need treatment to remove the pregnancy.
- Embryonic pregnancy: A fertilized egg that implants in the uterine wall without developing.
- Ectopic pregnancy: An embryo that develops outside the uterus, such as in the fallopian tube, cervix, ovary or abdomen, and can't survive. This can be a life-threatening condition if not identified and treated quickly.
- Molar pregnancy: A rare occurrence of abnormal tissue that grows instead of an embryo. It’s not a true pregnancy, but it can cause symptoms like missed periods, nausea and a positive pregnancy test.
- Stillbirth: A pregnancy loss at any time after 20 weeks. We have infant loss support programs to assist you through this.
Dealing with miscarriage and infant loss
Tamar Gur, MD, PhD, a perinatal psychiatrist, discusses ways to cope after an infant loss.
What causes a miscarriage?
While there are some common causes and risk factors for a pregnancy loss, it’s important to understand that a miscarriage is absolutely not your fault and there’s nothing you could’ve done to prevent it. The most common reason for an early miscarriage is that an embryo doesn’t develop properly due to genetic or chromosomal changes. These changes are usually random, and in many cases no clear cause is identified.
Other possible contributing factors may include:
- Hormonal imbalances
- Thyroid disease
- Uterine abnormalities
- Autoimmune or clotting disorders
- Uncontrolled chronic conditions, such as diabetes
- Certain infections
The following are not causes of miscarriages:
- Exercise
- Working
- Stress
- Sex
- Travel
Miscarriage signs and symptoms
Some people experience symptoms of a miscarriage, while others don’t have any symptoms and learn from their provider that a pregnancy isn’t viable. Vaginal bleeding or spotting doesn’t necessarily mean you’re having a miscarriage, but it can be a sign of one.
The following are symptoms of a miscarriage:
- Vaginal bleeding
- Cramping or pain in your lower abdomen or back
- Fluid or tissue that passes through the vagina
- A feeling of no longer being pregnant, including a decrease in pregnancy symptoms such as nausea or breast tenderness
What should you do if you have miscarriage symptoms?
You should call your provider right away if you have any concerns. You should go to the Emergency Department if you experience severe pain, fevers, chills or heavy bleeding greater than or equal to one pad per hour.
How is a miscarriage diagnosed?
If your provider suspects you’re experiencing a miscarriage, ultrasound imaging and blood tests may be recommended. If your pregnancy is in the very early stage, we might not be able to confirm a miscarriage. You may need to return for further testing in a few days.
Treatment options for miscarriage and pregnancy loss
Treatment depends on your medical condition, the number of weeks pregnant and personal preferences. Pregnancy tissue that remains in your body over time can cause infection and complications. Options to treat a miscarriage include:
Nonsurgical treatment
In some cases, during an early-stage pregnancy, your body may naturally pass pregnancy tissue over time. Your care team will monitor you closely to ensure the process is safe.
Prescription medication may help your body complete the miscarriage safely and more predictably.
Surgical treatment
A procedure called dilation and curettage (D&C) removes the pregnancy from your uterus. This may be recommended if there is heavy bleeding or an infection, or if your body doesn’t naturally pass the pregnancy or if you’re further along in the pregnancy.
Sometimes in second and third trimester pregnancy losses, labor may be induced.
Treatment for ectopic pregnancies
Sometimes ectopic pregnancies can be managed with medication, and other times surgery must be done to remove the pregnancy as well as the affected fallopian tube. Your doctor will guide you in the best course of treatment for your condition and symptoms.
How long does it take to recover from a miscarriage?
Recovery timelines will differ from person to person based on the type of pregnancy loss and a variety of other factors. However, most people may experience the following:
- Light to moderate bleeding or spotting for one to two weeks, but sometimes up to six weeks.
- Cramping that can be managed with rest, heating pads and over-the-counter pain relievers.
- Avoidance of inserting anything in the vagina (tampons, menstrual cups, intercourse) for one to two weeks for early pregnancy loss, or longer for later losses.
- A return to regular menstrual cycles at four to six weeks after the loss, although this varies.
Can I get pregnant again after a miscarriage?
Your future fertility is probably one of the most common questions following a pregnancy loss. Most people who have a miscarriage go on to have a healthy pregnancy and baby. Your provider will offer advice on when to try again, based on your physical recovery and emotional readiness. This is typically after your first normal period. We do recommend talking to your provider about contraception if you’re not ready to start trying again.
If you experience two or more miscarriages (recurrent miscarriages), your provider may recommend additional testing to identify possible causes. An evaluation may include:
- Preconception counseling and genetic testing for you and your partner
- Hormonal assessments
- Screening for autoimmune or clotting disorders
- Uterine imaging
- Referrals to reproductive endocrinology and infertility specialists
How can I prevent miscarriage?
Since a miscarriage or pregnancy loss is not your fault, it’s difficult to prevent one. That said, you can take steps to improve your likelihood of a healthy pregnancy.
- Manage any chronic health conditions that increase your risk of miscarriage, such as diabetes and hypertension.
- Take a folic acid prenatal vitamin with at least 400-800 micrograms of folic acid.
- Review medications that may not be safe in pregnancy, and adjust them if needed.
- Start prenatal care before 10-12 weeks.
- Avoid tobacco, alcohol and illicit drugs.
Dealing with infant and pregnancy loss
Grief is a normal emotional response following a miscarriage. Because we’re a large medical center, you’ll have access to mental healthcare and other support services, if needed, following your miscarriage. Medical resources for mental healthcare include:
- Our experts in Women’s Behavioral Health who have special training in working with women and families following pregnancy loss.
- Our walk-in clinic at Behavioral Health Urgent Care at The Ohio State University Wexner Medical Center Harding Hospital.
- Memorial events we host each year through our infant loss support program.
- National support lines (988 Suicide & Crisis Lifeline, Postpartum Support International).
- A referral to psychotherapy or support groups through your obstetrician/gynecologist.
Resources for pregnancy loss
- POEM for Moms, a program of Mental Health America of Ohio that offers peer support, resources, referrals, a sense of community, education and advocacy opportunities to moms and birthing persons.
- March of Dimes, a national organization that provides programs, education and support for every pregnant person and family.
- Share Pregnancy and Infant Loss Support Inc., a national group that provides support toward “positive resolutions of grief” during or following the death of a baby.
- Alive in My Heart, a central Ohio organization that supports families affected by pregnancy and infant loss with grief support groups, events and other resources.
- Let the Light In, resources and a compassionate community at no cost for those who experience pregnancy loss.
- Compassionate Friends, support and education to families who lose a child at any age for any reason.
- American Pregnancy Association, for articles about early pregnancy loss or stillbirth as well as physical and emotional recovery.
- Women's Health Pregnancy Loss, for information about why pregnancy loss happens, coping with loss and more resources.