Miscarriages occur in different forms. Learn what they are, including their symptoms and what treatment steps can follow.
Unfortunately, not all pregnancies are viable and miscarriages are more common than many think. Many do not know what exactly happens in the event of an unwanted pregnancy loss and what signs can indicate it.
In this article you will learn how an abortion can take place, what symptoms can occur with a new or existing miscarriage and what treatment steps can follow an abortion.
What is a miscarriage?
A miscarriage, also known as a spontaneous abortion, is usually defined as an unintended pregnancy loss before the 20th week of pregnancy. Miscarriages are estimated to be the most common form of pregnancy loss, and there are various forms in which they may happen. Distinctions are made based on the time that it occurs and whether the miscarriage requires medical management.
Why does a miscarriage occur?
The possible reasons for miscarriages can vary and vary from woman to woman. The most common reason is a genetic or chromosomal abnormality. According to one study where 233 missed miscarriages (miscarriages that are not accompanied with the usual symptoms) were examined, 75% of embryos had a chromosomal abnormality. Other risk factors may be hormonal imbalances, abnormalities in the uterus, immunological problems or the mother's age.
How common are miscarriages?
It is estimated that up to 70% of all conceptions can end in loss. This includes preclinical losses, miscarriages, and stillbirths. In clinically proven pregnancies, where the embryo and its heartbeat can be detected by ultrasound, the incidence rate is up to 15%. It often happens that the embryo is lost so early that the mother is unaware of the pregnancy or the miscarriage.
Most spontaneous abortions occur in the first trimester. The risk of miscarriage decreases after the 12th week of pregnancy. That's why many expectant mothers wait until the second trimester before informing those around them about their pregnancy.
The age of the mother plays a significant role in miscarriages. According to one study, the loss rate in women between the ages of 20 and 24 is only about 9%. In contrast, women between the ages of 40 and 44 have a 51% risk of miscarriage.
The types of miscarriages
There are different kinds of miscarriage, which can manifest themselves in different ways.
Threatened miscarriage (abortus imminens). In this case, a miscarriage has not yet occurred, but there are early signs that pregnancy loss may be imminent. The signs can be similar to those of other types miscarriage and can include vaginal bleeding and abdominal pain. However, the ultrasound image usually still shows a correctly positioned living fetus or embryo and a closed cervix.
Inevitable miscarriage (abortus incipiens). At the beginning of inevitable miscarriage, the cervix dilates. Signs can include bleeding and labor-like cramps of varying intensity. If the abortion has already begun, the complete or incomplete miscarriage can usually no longer be prevented.
Complete miscarriage (abortus completus): A complete abortion has the same signs as a threatened miscarriage and may follow an inevitable miscarriage. In a complete abortion, all of the pregnancy tissue (fetus, membranes and placenta) is eventually expelled. Bleeding and cramping may continue for several days, and it is still a good idea to visit a doctor to make sure that the the miscarriage is complete.
Incomplete miscarriage (abortus incompletus). During an incomplete abortion, which can follow an inevitable miscarriage or a missed miscarriage, only part of tissues and pregnancy is discharged from the uterus. This means that it is vital to seek medical care from a doctor or specialist. They will likely perform a dilation and curettage (D&C) procedure, which is a small surgical treatment to remove the remaining tissue.
Missed miscarriage. Also called a missed abortion, a missed miscarriage occurs when the fetus is not viable in the womb, but there are no outward signs of a miscarriage. In such cases, it does not develop further and dies in the uterus without the woman's body showing this. Accessing healthcare is also important in this case, as it is a incomplete miscarriage.
Septic miscarriage. A septic abortion is a type of miscarriage that is characterised by a fever between 38–39 °C, and a yellow discharge from the vagina. Without medical treatment, this type of miscarriage can be very dangerous. There is a risk of septic shock, which can lead to severe blood clotting disorders and even organ failure.
Other forms of pregnancy loss
In addition to miscarriage, forms of pregnancy loss include:
Preclinical or biochemical pregnancy loss
A miscarriage differs from biochemical pregnancy loss, which is the loss of an fertilised egg (embryo) prior to when it can be detected through ultrasonography. In this form of early pregnancy loss, the pregnancy hormone human chorionic gonadotropin (hCG) initially increases, and can be detected through a urine or blood test. Despite these positive hCG levels, the gestational sac (the structure that surrounds the embryo) is not visible during an ultrasound. This typically happens during the first 6 weeks.
Ectopic pregnancy
In contrast to a normal pregnancy which implants in the uterus (also known as an intrauterine pregnancy), an ectopic pregnancy (EP) implants elsewhere in the reproductive system or the abdominal cavity. EPs are reported to occur in 1–2% of all pregnancies, and 2–6% of pregnancies using assisted reproductive technologies (ARTs).
EPs are always nonviable, meaning that they will not live. This is because the embryo does not have the proper environment to grow or receive the necessary nutrients to develop. Beyond producing bleeding, infection and pain, EPs are also potentially life-threatening if they are not discontinued.
Although a spontaneous miscarriage can occur with an EP, ending the pregnancy typically involves surgical management or other medical treatment. For this reason, EPs are generally considered to be another form of pregnancy loss.
Habitual miscarriage
In medicine, a distinction is made between sporadic and recurrent miscarriages. A sporadic miscarriage is a random and unpredictable event. Most of the time it is a single event and there is no discernible pattern. Habitual abortions are recurring miscarriages. In the case of repeated miscarriages, it is advisable to get to the bottom of the cause.
Stillbirth
According to the World Health Organization, this form of early pregnancy loss is when a fetus dies in the uterus after 28 weeks of gestation. In contrast, in the United States, a stillbirth is considered to take place after 20 weeks of gestation.
What signs can indicate a miscarriage?
The signs of a miscarriage can vary from woman to woman. Some women have very pronounced symptoms, while others have only mild signs. In some cases, a woman may have an early miscarriage without knowing it. This can be because the symptoms are very mild, mimic menstrual bleeding, or do not occur at all. Many miscarriages are identified by the following signs:
Vaginal bleeding. The first sign of a miscarriage is often light bleeding (spotting), but this can also occur during pregnancy due to other causes, e.g. following intercourse or a gynecological exam. It thus may be harmless. A medical check-up should still be carried out.
In the case of medium to heavy bleeding (similar to menstrual bleeding and heavier), an immediate visit to the doctor is recommended. This type of bleeding often indicates a miscarriage has occurred or is imminent. In this case, blood clots or pieces of tissue may also be passed. Brown spotting can also indicate an impending miscarriage.
Cramps. A pull in the abdomen is not uncommon in the first few weeks of pregnancy and is usually harmless. However, severe abdominal cramps and pain in the lower abdomen can also be a symptom of a miscarriage, particularly if they are accompanied by bleeding. They may feel like menstrual cramps and involve back pain.
Pregnancy symptoms disappear. If there have been ongoing symptoms of pregnancy that stop, it is a good idea to see your medical specialist. However, the typical symptoms of pregnancy, such as breast tenderness or morning sickness, may also persist because the body does not immediately notice the loss of the fetus. Often, a missed abortion is discovered on a regular ultrasound scan, which does not detect cardiac activity in the embryo or fetus.
In addition to these symptoms, fever and nausea can also be signs of miscarriage.
Bleeding doesn't always mean miscarriage
During early pregnancy, a woman’s body undergoes multiple changes in order to adapt to its new task. Vaginal bleeding during the first trimester is not uncommon, and does not necessarily mean a loss of pregnancy.
In a study involving 4,510 pregnant women, 27% reported vaginal bleeding or spotting in the first trimester. About half of these women suffered a miscarriage. The remaining participants had other bleeds. In many cases, this bleeding does not occur due to problems with the placenta, but results from changes in the lining of the uterus. In the first 20 weeks of pregnancy, the following causes of bleeding are considered relatively harmless:
- Implantation bleeding: This can occur when the fertilised egg implants in the uterus. Small vessels can be injured, which leads to brief, bright red bleeding.
- Hormonal changes: At the beginning of pregnancy, progesterone levels can drop temporarily. This can cause spotting. Patients may be advised to take progesterone.
- Uterine polyp (growths from the lining of the uterus): Polyp-related bleeding in early pregnancy can easily be mistaken for a miscarriage. Polyps are usually harmless, but should be monitored.
- Infections of the vagina or cervix: While these are not dangerous for the baby, they should be treated as they can lead to premature labor or delivery.
- Uterine prolapse: This is a bulging of the uterine lining onto the cervix, which is usually painless.
- Contact bleeding: Small vessels can be injured by sexual intercourse or vaginal examinations and lead to spotting.
In most cases, this bleeding does not pose a risk to the pregnancy and the development of the baby. However, it should be noted that bleeding of any magnitude, even in the early stages of pregnancy, can be a first sign of potential complications.
What can I do if I have signs of a miscarriage?
If you have any signs of a miscarriage, such as bleeding and cramping, be sure to contact your ob-gyn to get to the bottom of it. If severe bleeding occurs suddenly, an immediate visit to the clinic is recommended. During the medical examination, your abdomen will be examined. Blood tests and an ultrasound will be done to determine if it is indeed a miscarriage.
The nurse will check to see if your cervix has dilated (indicating a miscarriage). An ultrasound scan can be used to determine whether the fetus is still alive. If a miscarriage has taken place, it can also be used to determine whether the amniotic sac and placenta have been passed in their entirety. The blood test is used, among other things, to measure hCG levels. A decrease in the hormone can indicate pregnancy loss.
If the doctor diagnoses an imminent miscarriage, rest and relaxation is usually recommended. This means, for example, avoiding heavy lifting and reducing stress. Sometimes it is recommended to take the hormone progesterone, which is said to help maintain the pregnancy. However, opinions on this are divided.
How is a miscarriage treated?
There are several treatment options for miscarriage. If the miscarriage is a complete miscarriage, in many cases the body will pass the embryo and other pregnancy-related tissue on its own. The gynecologist uses an ultrasound scan and a blood test to check whether the pregnancy has been completely discharged.
If this does not happen, medication may be given up to the 12th week of pregnancy to cause the cervix to open and the fetus to detach. According to one systematic review and meta-analysis, the combination of the medications mifepristone and misoprostol is an effective intervention up to 10 weeks of gestation. During a first trimester pregnancy, mifepristone blocks the hormone progesterone (which is needed for pregnancy to continue), and misprostol stimulates the uterus to expel the pregnancy.
In some cases, an abortion under general anesthesia may be needed to remove remaining pregnancy tissue from the uterus. If the fetus is already too large (from the 14th to 16th week of pregnancy), a stillbirth can be initiated with the addition of painkillers.
After a miscarriage or induced miscarriage, a woman's body needs time to recover. Recovery time can vary from person to person, and also depends on the stage of pregnancy loss and whether medical intervention was required. In addition to physical recovery, the processing of emotions is also an important part of healing. Our article, Recovery After Miscarriage, goes into more detail on this aspect.
Can I get pregnant after a miscarriage?
A miscarriage does not mean that a woman cannot give birth to a healthy child. In most cases, women who have had a miscarriage have a very good chance of becoming pregnant again. There are several factors that can affect the timing of trying to get pregnant again, such as the cause of the miscarriage and the treatment used. It is also important for the woman to feel physically and emotionally ready before attempting to conceive again.
Conclusion
A miscarriage is an unwanted loss of pregnancy. The signs of this can be different; most often there is pain and cramping in the lower abdomen accompanied by vaginal bleeding. But there are also women who hardly feel any symptoms.
If there is a suspicion of pregnancy loss, this should be clarified by a doctor. An ultrasound and blood tests can be used to determine whether a miscarriage has actually occurred. In many cases, the fetus and tissues are fully expelled. But it can also happen that part or all of the pregnancy remains in the uterine cavity. In these cases, medication or sometimes a small operation are required. In addition to physical recovery after a miscarriage, recovery on a psychological and emotional level also plays an important role.
Do you have questions about your fertility and your desire to have children? Our specialists are at your disposal. Secure your spot for a free consultation with our Cada medical team.
