Spontaneous early pregnancy loss, often called a miscarriage or spontaneous abortion, is a common experience among women. Up to 1 in 5 pregnancies is lost prior to 20 weeks and 4 out of 5 of these losses happen in the first 12 weeks. In fact, early miscarriage is so common that sometimes the pregnancy is not evident. In a classic study where the most sensitive research test was performed to detect the earliest sign of pregnancy, almost one third of the pregnancies failed after implantation and 70% of these losses occurred before the pregnancy was known to the woman or could be verified by the usual blood tests used by clinicians (1). Thankfully, after 15 weeks, the risk of pregnancy loss is less than 1% (2).
There are many factors that influence the risk of pregnancy loss. Many women I see are concerned about the effect of their age. This is a valid concern; in a Danish study of over 1 million pregnancies with known outcome, the rate of miscarriage was up to 20% for women age 35 and younger but 40% for women age 40, and 80% for women age 45 (3). Other risk factors include smoking, being overweight or obese, high levels of alcohol consumption (all alcohol consumption should be avoided because it is known to cause birth defects), illicit drugs and some chronic medical conditions.
Miscarriages are most often diagnosed when a pregnant woman starts to have bleeding, often with pain or cramping. However, it is important to know that bleeding and pain can also occur in a normal pregnancy and quite often will go away and the pregnancy will develop normally without problems. But any bleeding and pain in pregnancy should be evaluated by a doctor or midwife.
Sometimes, a woman’s story, along with a physical exam, may be all that is necessary to determine a miscarriage has occurred. Other times, an ultrasound may be advised to tell if the pregnancy is inside or outside the uterus. A pregnancy outside the uterus, also called an ectopic or tubal pregnancy, can be life threatening and needs immediate attention. An ultrasound can also detect a fetal heartbeat, which decreases the risk of loss.
Unfortunately, there is no way to stop a miscarriage. Many women will go through this process and need little help except support and follow up. Some women will benefit from medicine to help finish passing tissue, while others may prefer to have a minor procedure called a D&C to complete this process. Often, this can be done in the office safely and comfortably. After a miscarriage, the bleeding typically subsides after a week or two and a woman’s next period often comes in 4 to 6 weeks, if they had regular periods to begin with.
The loss of a pregnancy, no matter how early, can result in feelings of loss and sadness. Some women blame themselves unnecessarily, thinking there was something they could or should have done differently. Women often feel a range of symptoms. There may be relief if the pregnancy was unplanned. Others may feel anger or frustration. Physical feelings, such as headaches, fatigue, loss of appetite, trouble thinking or concentrating or even sleeplessness are common. And there may be tension between a woman and her partner. Sometimes, the emotional healing takes longer than the physical healing.
A woman should not blame herself for the loss of a pregnancy; rarely can it be prevented. And a miscarriage seldom means that a woman can’t have more children or there is something wrong with her body or health—most will have a normal pregnancy later.
If you’ve experienced a miscarriage, be gentle to yourself and give yourself time before attempting another pregnancy—you will know when the time is right. Talk to your doctor or midwife if you have questions or are having difficulty healing physically or emotionally.
Citations:
(1) Incidence of early loss of pregnancy. Wilcox AJ, Weinberg CR, O’Connor JF, Baird DD, Schlatterer JP, Canfield RE, Armstrong EG, Nisula BC. N Engl J Med. 1988;319(4):189-94.
(2) Age-specific risk of fetal loss observed in a second trimester serum screening population. Wyatt PR, Owolabi T, Meier C, Huang T. Am J Obstet Gynecol. 2005;192(1):240-6.
(3) Maternal age and fetal loss: population based register linkage study. Nybo Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M. BMJ. 2000;320(7251):1708-12.
