Miscarriage

What is miscarriage?

Miscarriage (also called early pregnancy loss) is pregnancy loss that happens before 20 weeks. It's estimated that between 10 to 20 in 100 known pregnancies (10 to 20 percent) end in miscarriage. Some research suggests that more than 30 percent of pregnancies end in miscarriage, and many end before a person even knows they’re pregnant. Most miscarriages - 8 out of 10 (80 percent) - happen in the first trimester before the 12^th week of pregnancy. Many people who miscarry are able to go on to have a healthy pregnancy later.

Understanding types of miscarriages

Miscarriages can happen in different ways, that’s why it’s important to know the different signs and symptoms.

Threatened miscarriage: This happens when there’s bleeding, little or no pain, and the cervix remains closed (undialated). The baby may still have a heartbeat, and in most cases, the pregnancy continues without issue.

Incomplete miscarriage: This means a miscarriage has happened, but the body doesn’t push out all of the tissue from pregnancy. You may have bleeding, cramping and other signs and symptoms of miscarriage.

Complete miscarriage: This is when your body pushes out all of the tissue from the pregnancy. You may pass tissue suddenly or after having medical treatment.

Asymptomatic miscarriage: Also called an empty sac pregnancy, it’s possible to have no symptoms at all, such as bleeding or cramping, and may require medical treatment to remove the tissue.

Repeat miscarriages. Recurrent pregnancy loss is when two or more consecutive miscarriages occur. The risk of future miscarriages increases after each loss.

What are repeat miscarriages and what causes them?

Repeat miscarriages, or recurrent pregnancy loss, is the loss of two pregnancies in a row. About 2 in 100 pregnant people (2 percent) have repeat miscarriages.

We don’t know what causes every miscarriage. But some miscarriages and repeat miscarriages can be caused by:

Problems with chromosomes

This usually happens by chance and is not caused by a problem that’s passed from parent to child through genes. Chromosomes are the structures in cells that holds genes. Each person has 23 pairs of chromosomes, or 46 in all. For each pair, you get one chromosome from your mother and one from your father. 

Problems with the uterus or cervix.

Problems with the uterus and cervix that can cause miscarriage after 12 weeks but before 20 weeks include:

• Septate uterus. This is when a band of muscle or tissue (called a septum) divides the uterus in two sections. If you have a septate uterus, your provider may recommend surgery before you try to get pregnant to repair the uterus to help reduce your risk of miscarriage. Septate uterus is the most common kind of congenital uterine abnormality. Septate uterus is a common cause of repeat miscarriages.
• Asherman syndrome. If you have this condition, you have scars or scar tissue in the uterus that can damage the endometrium (the lining of the uterus). Before you get pregnant, your provider may use a procedure called hysteroscopy to find and remove scar tissue. Asherman syndrome may often cause repeat miscarriages that happen before you know you’re pregnant.
• Fibroids and polyps or scars from surgery on the uterus. Fibroids, polyps and scars can limit space for your baby or interfere with your baby’s blood supply. Before you try to get pregnant, you may need a surgery called myomectomy to remove them.
• Cervical insufficiency (also called incompetent cervix). This is when your cervix opens (dilates) too early during pregnancy, usually without pain or contractions. To help prevent this, your provider may recommend cerclage. This is a stitch your provider puts in your cervix to help keep it closed.

Infections

Infections can cause miscarriage.  Common infections include:

• Parvovirus B19. Parvovirus causes fifth disease, a common childhood illness.
• Cytomegalovirus
• Sexually transmitted infections (STIs).  STIs, such as genital herpes and syphilis, are infections you can get from having sex with someone who is infected. If you think you may have an STI, tell your health care provider right away. Early testing and treatment can help protect you and your baby. 
• Listeriosis.  Listeriosis is a kind of food poisoning. If you think you have listeriosis, call your provider right away. Your provider may treat you with antibiotics to help keep you and your baby safe.

Other possible causes of miscarriage include:

• Abnormal blood clots
• Placental abruption
• Premature rupture of the membranes (PROM). PROM is when the amniotic sac around your baby breaks (your water breaks) before labor starts.
• Preterm labor

Are you at risk for a miscarriage?

Some things may make you more likely than other pregnant people to have a miscarriage. These are called risk factors. Risk factors for miscarriage include:

• Having two or more previous miscarriages
• Being 35 or older. As you get older, your risk of having a miscarriage increases. The age of your partner also may increase the risk of miscarriage.
• Smoking, drinking alcohol or using street drugs. Street drugs include cocaine and methamphetamines. If you’re pregnant or thinking about getting pregnant and need help to quit, tell your provider.  
• Being exposed to harmful chemicals. You or your partner having contact with harmful chemicals, like solvents, may increase your risk of miscarriage. A solvent is a chemical that dissolves other substances, like some detergent mixtures and paint thinner. Exposure to lead, arsenic, radiation or air pollution can also be harmful. Talk with your provider about what you can do to protect yourself and your baby.

Some health conditions may increase your risk for miscarriage. Treatment of these conditions before and during pregnancy can sometimes help prevent miscarriage and repeat miscarriages. If you have any of these health conditions, tell your health care provider before you get pregnant or as soon as you know you’re pregnant: 

• Autoimmune disorders. These health conditions happen when the body attacks its own healthy tissue by mistake. Autoimmune disorders that may increase your risk of miscarriage include antiphospholipid syndrome and lupus (also called systemic lupus erythematosus or SLE). If you have antiphospholipid syndrome, your body makes antibodies that attack certain fats that line the blood vessels; this can sometimes cause blood clots. If you have antiphospholipid syndrome and have had repeat miscarriages, your provider may give you low-dose aspirin and a medicine to help prevent another miscarriage.
• Obesity. This means your body mass index (also called BMI) is 30 or higher. BMI is a measure of body fat based on your height and weight. To find out your BMI, use the CDC's BMI calculator.
• Hormone problems, such as polycystic ovary syndrome (also called PCOS) and luteal phase defect. Hormones are chemicals made by the body. Progesterone is a hormone that helps regulate your periods and gets your body ready for pregnancy. Luteal phase defect is when you have low levels of progesterone over several menstrual cycles. If you have luteal phase defect, your provider may recommend treatment with progesterone before and during pregnancy to help prevent repeat miscarriages.
• Preexisting diabetes 
• Preexisting hypertension
• Thyroid problems
• Severe kidney disease
• Congenital heart disease
• Severe malnutrition. This means not getting enough food or nutrients before getting pregnant.
• Group B beta strep infection
• Certain prenatal tests, such as amniocentesis and chorionic villus sampling. These tests have a slight risk of causing a miscarriage. Your provider may recommend them if your baby is at risk for certain genetic conditions, such as Down syndrome.

Having an injury to your belly, such as from falling or getting hit or a motor vehicle accident, may be a risk for miscarriage depending on the force of the injury or fall. Your body usually does a good job of protecting your baby in the early weeks of pregnancy. If this happens, contact your provider to make sure you and your baby are not injured.

Other factors that may increase your risk of miscarriage include:

• Certain medications. Some studies show that nonsteroidal anti-inflammatory medications (also called NSAIDS) including ibuprofen, naproxen and diclofenac may increase risk. NSAIDs are a type of medicine used to relieve pain and swelling. The acne medicine isotretinoin has also been linked to miscarriage and fetal abnormalities.
• Getting pregnant while using an intrauterine device (IUD). IUDs are devices placed in your body to prevent pregnancy. In rare cases, people can get pregnant while using an IUD.
• Stress. Both short, intense times of stress and long-term stress can increase the risk of miscarriage.

You may have heard that getting too much caffeine during pregnancy can increase your risk for miscarriage. Caffeine is a drug found in foods, drinks, chocolate and some medicine. It’s a stimulant, which means it can help keep you awake. More research is needed to understand the effect of caffeine on pregnancy. Until we know more about how caffeine can affect pregnancy, it’s best to limit the amount you get to 200 milligrams each day. This is what’s in about one 12-ounce cup of coffee.

You also may have heard that having sex or exercising while pregnant can cause a miscarriage. There is no proof that this is true.

How can you prevent a miscarriage?

Miscarriages usually can’t be prevented, but being healthy before pregnancy can help prevent pregnancy complications. Good pre-pregnancy health includes getting a pre-pregnancy checkup and talking with your provider about health conditions that can affect your pregnancy. It also includes taking folic acid to help prevent birth defects and making changes in your life that may affect the health of your baby.

What are the signs and symptoms of miscarriage?

Signs and symptoms of miscarriage include:

• Bleeding from the vagina or spotting. Many people experience spotting early in their pregnancy. In most cases, it is not a sign of miscarriage. To be safe, if you have spotting or any of these signs or symptoms, call your provider.
• Cramps, like the ones you have with your period
• Severe belly pain
• Back pain
• Vaginal discharge with a bad smell
• Fever

Many pregnant people have these signs and symptoms in early pregnancy and don’t have a miscarriage. But if you think you might be having a miscarriage, tell your health care provider right away. Your provider may want to do some tests to make sure everything’s OK. These tests can include blood tests, a pelvic exam and an ultrasound.

What treatment do you get after a miscarriage or repeat miscarriages?

Treatment depends on how far along you were in your pregnancy, your overall health, your age and other factors. If you’ve had a miscarriage, your provider may recommend:

1. Dilation and curettage (also called D&C). This is a procedure to remove any remaining tissue from the uterus. Your provider dilates (widens) your cervix and removes the tissue using an instrument called a curette.
2. Dilation and extraction (also called D&E). This is a procedure to remove any remaining tissue from the uterus. Your provider dilates (widens) your cervix and removes the tissue using suction.
3. Medicine. Your provider may recommend medicine that can help your body pass tissue that’s still in the uterus. If your blood type is Rh negative, you also may get a shot of Rh immunoglobulin after any miscarriage or bleeding episode in pregnancy. This can help prevent problems with future pregnancies. Rh immunoglobulin is a medicine that stops a person who is Rh negative from reacting to Rh-positive blood.

Do you need any medical tests after a miscarriage or repeat miscarriages?

If you miscarry in your first trimester, you probably don’t need any medical tests. Because we don’t often know what causes a miscarriage in the first trimester, tests may not be helpful in trying to find out a cause.

If you have repeat miscarriages in the first trimester, or if you have a miscarriage in the second trimester, your provider usually recommends tests to help find out the cause. Tests can include:

• Chromosome tests. 
• Hormone tests.
• Blood tests to check your immune system. 
• Looking at the uterus. 

How long does it take to recover from a miscarriage?

It can take a few weeks to a month or more for your body to recover from a miscarriage. Depending on how long you were pregnant, you may have pregnancy hormones in your blood for 1 to 2 months after you miscarry. Most women get their period again 4 to 6 weeks after a miscarriage. Talk to your provider about how to care for yourself during this time.

It may take longer to recover emotionally from a miscarriage. You may have strong feelings of grief about the death of your baby. Grief can make you feel sad, angry, confused or alone. It’s OK to take time to grieve after a miscarriage. Ask your friends and family for support, and find special ways to remember your baby. For example, if you already have baby things, like clothes and blankets, you may want to keep them in a special place. Do what’s right for you. Ask your provider about support groups or services that can help you with recovery from grief.

Certain things, such as hearing names you were thinking of for your baby or seeing other babies, can be painful reminders of your loss. You may need help learning how to deal with these situations and the feelings they create. A support group can help. Tell your provider if you need help to deal with your grief.

If you miscarry, when can you try to get pregnant again?

This is a decision for you to make with your partner and your provider. Be sure to take a vitamin supplement that has 400mcg of folic acid even if you don’t get pregnant right away. If you’re having medical tests to try to find out more about why you miscarried, you may need to wait until after you’ve had these tests to try to get pregnant again.

You may not be emotionally ready to try again so soon. Miscarriage can be hard to handle, and you may need time to grieve. It’s OK if you want to wait a while before trying to get pregnant again.

More information

From Hurt to Healing (free booklet from the March of Dimes for grieving parents)

Centering Corporation (grief information and resources)

Share Pregnancy & Infant Loss Support (resources for families with pregnancy or infant loss)

Last reviewed: October 2024