Miscarriage: Signs, What Happens, and When to Call
A miscarriage is the loss of a pregnancy before 20 weeks. It is common, and it is very often not caused by anything the mother did. It can still be a painful loss, both physically and emotionally.
This article explains the signs, the most common causes, how a miscarriage is diagnosed and treated, and when to get urgent care. If you are early in pregnancy and want to know what to expect, see Early Signs of Pregnancy: What You May Notice Before a Test.
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Quick Answer
A miscarriage is the unexpected loss of a pregnancy before the 20th week. About 10% of confirmed pregnancies end this way, according to the NICHD (1). The most common signs are vaginal bleeding, cramps or pain in the lower belly, and low back pain (2). Contact your provider right away if you have any of these signs during pregnancy.
What a Miscarriage Is
A pregnancy loss can happen so early that a woman may not know she was pregnant (1). The real number of miscarriages is hard to know, because some happen before a pregnancy is confirmed. This is one reason why a late or heavier period can sometimes be an early loss. See Why Is My Period Late? for other reasons a period can change.
Signs and Symptoms
The NICHD lists these signs of a miscarriage (2):
- Bleeding from the vagina.
- Pain or cramps in the lower belly.
- Low back pain.
- Fluid, tissue, or clot-like material coming out of the vagina.
Some women have no symptoms at all, and the loss is found at an ultrasound. Bleeding in early pregnancy does not always mean a miscarriage is happening (2). Still, any of these signs needs a call to your provider, who can tell you what is going on.
Why It Happens
MedlinePlus explains that most miscarriages happen because the baby does not develop properly, often because of a chromosome problem. In many cases the cause is never found (3). This means that a miscarriage is usually not caused by something you did or did not do.
Some things raise the risk. The NICHD names age over 35, long-term health conditions such as high blood pressure, diabetes, or thyroid disease, PCOS, smoking, alcohol or drug use, and more than 200 milligrams of caffeine a day (4). Having a risk factor does not mean you will have a loss, and many women with none have one.
What Happens Next
Testing
Your provider may do a pelvic exam, a blood test for the pregnancy hormone hCG, and an ultrasound to look at the pregnancy, the uterus, and the placenta (5). Sometimes the tests need to be repeated a few days later before the answer is clear. Falling hCG levels may mean a pregnancy loss is likely, but an ultrasound is usually needed to confirm it (6).
On the ultrasound, your provider looks for signs that the pregnancy is developing, and the scan may be repeated to see whether it is growing (6). After a miscarriage, your provider will schedule a follow-up visit, with an ultrasound if needed, to make sure all the tissue has passed (6). If some tissue remains, a D&C may be recommended.
Treatment Options
The right choice depends on how far along you are and how you feel. In many cases, no special treatment is needed, because the bleeding empties the uterus on its own (5). A medicine called misoprostol can help the tissue pass, and the NICHD says it is safe and effective in most cases (5).
A procedure called dilation and curettage (D&C) is recommended if you are bleeding heavily or an ultrasound shows tissue still in the uterus (5). If your blood type is Rh negative, ask whether you need an Rh immune globulin shot. MedlinePlus notes that this can be needed at 12 weeks or later (3).
When to Get Urgent Care
Contact your provider right away if you are bleeding heavily, which the NICHD defines as soaking at least two maxi pads an hour for at least two hours in a row (5). Cleveland Clinic also lists passing large clots, bigger than a golf ball, as a reason to call (6). If you are worried, do not wait to reach these limits, because your provider would rather hear from you early.
A miscarriage can sometimes cause an infection of the uterus, which can be life-threatening. Call 911 if more than a day after the loss you have (5):
- A fever higher than 100.4°F on more than two occasions.
- Severe pain in the lower belly.
- Bloody discharge from the vagina that smells bad or contains pus.
Sudden, severe pain on one side of the belly, shoulder tip pain, dizziness, or fainting can be signs of an ectopic pregnancy. This is an emergency. Early Signs of Pregnancy describes these signs in more detail.
Taking Care of Yourself
Grief after a miscarriage is normal, even when the loss was very early. There is no right way or right length of time to feel it. Counseling and support can help (3). If sadness or anxiety does not ease or gets in the way of daily life, How to Know If You Need Therapy can help you decide on a next step.
Before you try to become pregnant again, talk with your provider about your own risks. Many women go on to have healthy pregnancies after a miscarriage (3). Your provider can also tell you when it is safe to start trying and what tests, if any, are worth doing.
Conclusion
Miscarriage is common and is usually caused by a problem with the baby’s development, not by anything the mother did. Bleeding, lower belly pain, and back pain are the main signs, so call your provider. Treatment depends on how far along you are, and many women need no procedure. Heavy bleeding, fever, or severe pain needs urgent care. Be gentle with yourself, and ask for support.
Sources
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). About Pregnancy Loss (Before 20 Weeks of Pregnancy).
- NICHD. What Are the Symptoms of Pregnancy Loss?
- MedlinePlus (National Library of Medicine). Miscarriage.
- NICHD. What Are the Causes and Risks of Pregnancy Loss?
- NICHD. How Do Health Care Providers Diagnose and Treat Pregnancy Loss?
- Cleveland Clinic. Miscarriage.
