Introduction

Parenthood is a journey full of surprises and joys. Every curve and turn holds the promise of a happy ending. However, miscarriages serve as an unexpected detour for many people on this journey.

The term “miscarriage” is often used to describe a medical event, but it’s a term that doesn’t accurately capture the true meaning of the term.

A miscarriage is more than just a medical event. It’s a loss that can impact women and their loved ones in unexpected ways, and it’s often difficult to talk about openly.

Miscarriage is a fairly common experience, but that doesn't make it any easier.

Learn about the potential causes of a miscarriage, factors that increase the risk, and the medical care that may be necessary.

In this blog, we delve into the delicate and often misunderstood realm of miscarriage – exploring its causes, deciphering the subtle symptoms, unraveling the diagnostic puzzle, and navigating the risks and treatments.

What is a Miscarriage?

A miscarriage, medically known as a spontaneous abortion, is the termination and expulsion of an embryo or fetus before it can survive independently. This usually occurs before the 20th week of pregnancy.

Losses that occur after 20 weeks are referred to as stillbirths. Just because it’s called a “miscarriage” doesn’t mean you did something wrong in carrying the pregnancy.

Most miscarriages are beyond one’s control and occur because the fetus stops growing.

Types of Miscarriage

There are various types of miscarriages, each with its own characteristics:

Threatened miscarriage: It’s the most common kind of miscarriage and happens when there is light vaginal bleeding or cramping at the beginning of pregnancy (usually within the first trimester), but the cervix stays closed. The pain and bleeding may improve, allowing for a healthy pregnancy and baby, or the cervix may open, leading to a miscarriage.

Inevitable miscarriage: An inevitable miscarriage has already begun. It is characterized by the onset of vaginal bleeding and cramping, signaling the initiation of the miscarriage process. Additionally, the cervix will be open, allowing the pregnancy tissue to pass with the bleeding.

Complete miscarriage: In this type of miscarriage, all of the pregnancy tissue has left the uterus. Cramping pain can occur as the uterus contracts to empty its contents. An ultrasound can confirm a full miscarriage.

Incomplete miscarriage: In an incomplete miscarriage, some fetal tissue has been passed, but some tissue remains in the uterus. This can lead to ongoing bleeding and uterine cramping. Surgery may be recommended to remove any remaining tissue.

Missed miscarriage: In a missed miscarriage, the baby’s embryo or fetus is dead, but the body doesn’t get rid of the remaining fetal tissue. A missed miscarriage can occur in the first few weeks of pregnancy, and there may not be any symptoms. Usually, a missed miscarriage is diagnosed at a routine ultrasound.

Recurrent miscarriage: It occurs when two or more consecutive pregnancies end in miscarriage. Each miscarriage may involve vaginal bleeding and cramping pain, similar to strong period pain, as the uterus contracts to expel the pregnancy tissue.

Chemical pregnancy: A chemical pregnancy is a miscarriage that occurs very early in pregnancy, often before a woman even realizes she is pregnant. A chemical pregnancy occurs when implantation of a fertilized egg into the uterus occurs, but the embryo doesn’t develop. There may be some spotting or light spotting, but there’s usually no cramping.

What Routine Doesn’t Cause Miscarriages?

​Routine activities such as these don't cause a miscarriage:

• Exercise, as long as you're healthy. However, consult the pregnancy care team first and avoid activities that may cause injury, like contact sports.
• Sex.
• Use of birth control pills before getting pregnant.
• Work is safe as long as one is not exposed to excessive amounts of dangerous chemicals or radiation. Consult a healthcare provider if there are risks related to the job.

Symptoms of Miscarriage

Here are some of the potential symptoms of miscarriage:

Vaginal bleeding: This can vary from light spotting to heavy bleeding, and the color can range from pink to red to brown.

Cramping or pain in the lower abdomen: It can range from mild to severe and may resemble menstrual cramps.

Passing tissue or clots from the vagina: Not all miscarriages involve this symptom.

A decrease in pregnancy symptoms: This may involve nausea, vomiting, breast tenderness, and fatigue. Some women may have these symptoms even after a miscarriage.

Factors that Increase the Likelihood of Miscarriage

Age: Women under 35 are at a 15% risk of miscarriage, and women over 40 are at a 40% risk. This is mainly because of the increased risk of the fetus having chromosomal abnormalities.

Previous miscarriage: Women with a history of at least one previous miscarriage are at a higher risk.

Suffering from long-term conditions: Women who have a chronic health condition like uncontrolled diabetes may have a higher risk of miscarriage.

Uterine or cervical problems: Some uterine conditions and weak cervical tissues (incompetent cervix) can increase the risk of miscarriage.

Smoking, alcohol, caffeine, and illegal drugs: People who smoke have a greater risk of miscarriage than nonsmokers. Heavy use of caffeine or alcohol also raises the risk. So does using illegal drugs such as cocaine.

Weight: Women who are underweight or overweight may experience a greater risk of miscarriage.

Thyroid: Both hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) can affect pregnancy outcomes and increase the risk of miscarriage if not properly managed.

Polycystic Ovary Syndrome (PCOS): Women with PCOS have higher levels of androgens and insulin resistance, which can lead to hormonal imbalances and increase the risk of miscarriage. Proper treatment and management of PCOS can help reduce this risk.

Causes of Miscarriage

Several factors can contribute to a miscarriage, and they can be broadly categorized into the following:

Chromosome abnormalities: These are the most common causes of miscarriage and account for about 50% of all cases of miscarriage. Chromosomes are structures that contain genes. When a developing baby has an abnormally high number of chromosomes, it can affect the fetus's health. Chromosomal abnormalities usually occur by accident and are not a result of the individual’s actions.

Medical conditions: Certain medical conditions, like uncontrolled diabetes, thyroid disease, and autoimmune disorders can increase the risk of miscarriage.

Lifestyle factors: Bad lifestyle habits like smoking, consuming alcohol, and taking illegal drugs may increase the risk for other pregnancy complications, but their involvement in miscarriage is less known. However, it is still advised to abstain from these lifestyle choices during pregnancy.

Cervical insufficiency: The condition in which the cervix, the opening to the uterus, weakens and opens too early during pregnancy. This can lead to miscarriage or premature birth.

Uterine fibroids: These are non-cancerous tumours that develop in the uterine muscle. They do not always cause any problems, but they can sometimes affect implantation or fetal development.

Stress or Trauma: High levels of stress or trauma can negatively impact pregnancy and increase the risk of miscarriage.

Anxiety and Depression: Mental health conditions like anxiety and depression can affect overall health and increase the risk of miscarriage. The emotional impact of experiencing a previous pregnancy loss can further elevate the risk factors for subsequent miscarriages.

Relationship Issues: Stressful or unstable relationships can contribute to emotional distress, potentially affecting pregnancy outcomes.

Sleep-related Issues: Poor sleep quality or sleep disorders can negatively impact overall health and increase the risk of miscarriage.

Diagnosis of Miscarriage

Only a licensed healthcare professional should be able to diagnose a miscarriage because it is a medical procedure.

They will use a combination of methods to confirm a miscarriage, including:

Blood tests: Blood tests can measure the amount of hCG, a hormone produced during pregnancy. Low levels of hCG can be a sign that you are having an abortion.

Physical exams: These may include a pelvic examination to see if the cervix is dilated, which can be an indication that you are having a miscarriage.

Ultrasounds: This common test will check if the fetus is developing properly and if there’s a heartbeat. A transvaginal ultrasound is a type of ultrasound that involves inserting a small probe into the vagina.

Tissue tests: If what had passed appears to be tissue, the doctor will send it to a lab to make sure that the symptoms aren’t connected to another cause.

Chromosome testing: If there is more than one miscarriage, the doctor may suggest blood tests for the couple. These tests can help determine whether the chromosome makeup of the couple may be associated with an increased risk of miscarriage.

Treatment for Miscarriage

• If the miscarriage is terminated and the uterus is empty, any additional treatment may not be required.
  
• But in some cases, the tissue does not come out completely. In such cases, the patient may be advised to wait a week or two until it passes naturally. Otherwise, they may perform a D&C, which involves dilating the cervix and removing any remaining tissue. Medications may be prescribed to cause any remaining tissue to leave the uterus.
• If the abortion occurs later in pregnancy and the fetus dies in the uterus, the doctor may decide to induce labour.
• If the cervix dilates on its own during pregnancy, it may indicate a condition called incompetent cervix. In this case, the doctor may perform a procedure called a cerclage.
• Including mental health support in miscarriage, treatment is crucial for comprehensive care. By recognizing and addressing the emotional and psychological needs of individuals who have experienced a miscarriage, healthcare providers can significantly improve overall well-being.

Conclusion

The path to recovery after a miscarriage is different for everyone.

Many women experience an abortion, and there are many resources and support groups to help you through this difficult time.

Taking care of oneself, focusing on mental and emotional health, and seeking professional assistance is recommended. 

If considering pregnancy, consult a healthcare provider to discuss timing and any questions.

FAQs

How do I confirm a miscarriage at home?

If you experience symptoms like bleeding and cramping or notice a disappearance of pregnancy signs such as morning sickness or breast tenderness, consider consulting a doctor.

What’s the difference between a miscarriage and a stillbirth?

Both are pregnancy losses, but the distinction lies in the timing. Healthcare professionals classify it as a miscarriage if it occurs within the initial 20 weeks, and as a stillbirth if it happens after 20 weeks.

What’s the difference between a miscarriage and an abortion? 

According to science, an abortion is any pregnancy that terminates before the fetus is viable. Spontaneous abortion is often referred to as an abortion. The term “induced abortion” is often used to describe a pregnancy that is terminated intentionally by a medical procedure or medication.

Can I get pregnant after I’ve had a miscarriage?

Most women who have had a miscarriage go on to have healthy pregnancies and babies. Having a miscarriage does not necessarily indicate a problem with fertility. Most miscarriages are due to a chromosomal anomaly, not due to an individual’s actions.

How long does the bleeding last?

Pregnancy losses that occur in the first weeks of pregnancy tend to cause bleeding that lasts a few days. Those that occur later may cause bleeding that lasts for as long as 4 weeks.

References

• Mayo Clinic (2023). Miscarriage: Causes, Symptoms, Diagnosis and Treatment. Available at https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/symptoms-causes/syc-20354298 (Accessed 25/02/2024).
  
• Healthline (2023). Everything You Need to Know About Miscarriage. Available at https://www.healthline.com/health/miscarriage#treatment (Accessed 25/02/2024).
• WebMD (2023). Miscarriage. Available at https://www.webmd.com/baby/pregnancy-miscarriage (Accessed 25/02/2024).
• Cleveland Clinic (2022). Miscarriage. Available at https://my.clevelandclinic.org/health/diseases/9688-miscarriage (Accessed 25/02/2024).
• Medical News Today (2022). Miscarriage: What You Need to Know. Available at https://www.medicalnewstoday.com/articles/262941#causes (Accessed 25/02/2024).
• Very Well Family (2022). What is a chemical pregnancy? Available at https://www.verywellfamily.com/chemical-pregnancy-a-very-early-miscarriage-2371493 (Accessed 25/02/2024).
• East Side Gynaecology (2022). What to do after a miscarriage. Available at https://eastsidegynecology.com/blog/what-to-do-after-miscarriage/ (Accessed 25/02/2024).
• American Psychological Association, Miscarriage and Loss, Elizabeth Leis-Newman June 2012, Vol 43, No. 6. Available at: https://www.apa.org/monitor/2012/06/miscarriage
• National Institute for Health and Care Research, Pregnancy loss leads to post-traumatic stress in one in three women, Feb 2021. Available at: https://evidence.nihr.ac.uk/alert/pregnancy-loss-post-traumatic-stress/. 
• Jade E. Bilardi, and Meredith Temple-Smith, We know all too well the significant psychological impact of miscarriage and recurrent miscarriage: so where is the support? Fertility and Sterility, Volume 120, Issue 5, 2023, Pages 937-939, ISSN 0015-0282, https://doi.org/10.1016/j.fertnstert.2023.08.951. (https://www.sciencedirect.com/science/article/pii/S0015028223017181)