If a woman loses her baby in the first 3 months of pregnancy, it is called an early miscarriage. Most women experience vaginal bleeding but sometimes there may be no symptoms. If this is the case, the miscarriage may be diagnosed by an ultrasound scan.
What causes miscarriage?
The most common cause of an early miscarriage is thought to be a problem with the baby’s chromosomes. Early miscarriage is very common. One in five women at the age of 30 will have a miscarriage, and the risk is increased by women’s age. Over the age of 40, the miscarriage rate can be as high as 50%. The risk is also increased by medical problems such as poorly controlled diabetes, lifestyle factors such as smoking, being overweight or heavy drinking. There is, however, no evidence that stress or sex during pregnancy can cause miscarriage.
How is an early miscarriage diagnosed?
An early miscarriage is usually diagnosed by an ultrasound scan. Sometimes a blood test for pregnancy hormone (β-hCG) level may be necessary to help make the diagnosis.
What are my choices if a miscarriage is confirmed?
If a miscarriage is confirmed but some or all of the pregnancy is still inside the womb, the woman may choose to wait and let nature take its course, to use medicines, or to have an operation.
1) Letting nature take its course (Expectant management of a miscarriage)
This is successful in about 50 out of 100 women who chooses this option. It can take some time before the bleeding starts and this may continue for up to 3 weeks. It may be heavy and the woman may experience cramping pain. If the woman has severe pain or very heavy bleeding, she may need to be admitted to hospital.
2) Taking Medication (Medical management of a miscarriage)
This is successful in 85 out of 100 women, thus avoids an operation. The doctor will prescribe a medication called misoprostol, either as vaginal pessaries or oral tablets. The medication helps the neck of the womb (cervix) to open and lets the pregnancy come away. It will take a few hours and there will be some pain with bleeding or passing clots like a heavy period. Painkillers can be taken if necessary. Some women may experience diarrhoea and vomiting. The bleeding may last for up to 3 weeks. The woman will be given an appointment to check if the medication has worked. If the treatment has not worked, or if the bleeding is too heavy, the woman will need an operation.
3) Having an operation (Surgical management of a miscarriage, suction evacuation)
The operation is usually carried out under general anaesthetic. It is successful in 95 out of 100 women. The pregnancy is removed through the cervix. The woman may be give tablets to swallow or vaginal pessaries before the operation to soften the cervix. Surgery will usually take place within a few days of the miscarriage but the woman may be advised to have surgery immediately if she is bleeding heavily and continuously or if there are signs of infection. The operation is safe but there is a small risk of complications including heavy bleeding, infection or damage to the womb. A repeat operation is sometimes required if there is still pregnancy remains left behind.
What happens next?
Vaginal bleeding:
The woman can expect to have some vaginal bleeding for 1‒2 weeks after the miscarriage, and may be up to 3 weeks with expectant or medical management. This is like a heavy period for the first day or so. This should lessen and may become brown in colour. The woman should use sanitary towels rather than tampons, as using tampons could increase the risk of infection.
If the woman normally has regular periods, the next period will usually be in 4‒6 weeks’ time. Ovulation occurs 2 weeks before this. Therefore, if the woman does not want to become pregnant, she will need to use contraception.
Abdominal discomfort:
The woman can expect some cramps like strong period pains in the lower abdomen on the day of the miscarriage. She may get milder cramps or an ache for a day or so afterwards. If the discomfort is not relieved by simple painkillers and if she experiences the following symptoms, she should seek medical advice:
Heavy or prolonged vaginal bleeding, smelly vaginal discharge, abdominal pain and a raised temperature may indicate an infection of the womb. This occurs in 2‒3 out of 100 women. It can be treated with antibiotics. These symptoms can also indicate that some tissues remain from the pregnancy.
Increasing abdominal pain, running a temperature, lost appetite and vomiting may indicate a damage to the uterus. The woman may need to be admitted to hospital.
Returning to work
It is advisable to rest for a few days before starting routine activities but returning to work within a day or two will not cause harm if the woman feels well enough. Most women will return to work in a week.
Having sex
The woman can have sex as soon as she and her partner both feel ready. It is important that she is feeling well and that any pain and bleeding has subsided.
When can we try for another baby?
The woman can try for a baby as soon as she and her partner feel physically and emotionally ready.
Is the woman at higher risk of a miscarriage next time?
The woman is not at higher risk of another miscarriage if she has had one or two early miscarriages. Most miscarriages occur as a one-off event and there is a good chance of having a successful pregnancy in the future. A very small number of women who have had three or more early miscarriages (recurrent miscarriages) will need further investigations to see if they have a condition that makes them more likely to miscarry.
