Miscarriage — early pregnancy loss

Miscarriage ( early pregnancy loss ) — death of embryo/fetus before 24 weeks (UK legal definition; viability threshold ~23–24 weeks).

~1 in 8 confirmed pregnancies — majority first trimester — devastating despite statistical commonness.

Symptoms

Common presentation:

  • vaginal bleeding — red or brown
  • cramping — period-like
  • passing products of conception

Types:

  • Threatened — bleeding, scan shows heartbeat — 50% continue
  • Inevitable — cervix open, bleeding
  • Incomplete — retained tissue — needs treatment
  • Complete — all tissue passed
  • Missed — no symptoms, scan shows no heartbeat

Always exclude ectopic

Bleeding + pain early pregnancy — ** ectopic until proven otherwise**

Shoulder tip pain, collapse — 999 — ruptured ectopic

Early pregnancy unit — TV scan, hCG serial if early

Causes

First trimester (~85%):

  • random chromosomal error — aneuploidy — not inherited fault, not caused by stress

Later / recurrent:

  • uterine septum, fibroids cavity
  • cervical insufficiency — mid-trimester
  • APS — antiphospholipid syndrome
  • thyroid, diabetes
  • infection — Listeriosis etc.

NOT caused by:

  • moderate exercise
  • sex
  • work stress
  • ** morning sickness tablets** (usual)

Management options

Expectant management:

  • wait — complete in days to 2 weeks
  • suitable if stable, early, patient choice

Medical management:

  • misoprostol — vaginal/oral — 84% complete — pain/bleeding expected

Surgical:

  • MVA (manual vacuum aspiration) — under GA or local
  • if failed medical, infection, haemorrhage, patient preference

Anti-D immunoglobulin — Rhesus negative women — after certain events

After miscarriage

Physical:

  • bleeding 1–2 weeks
  • avoid tampons until settled — infection risk
  • sex when comfortable — when bleeding stopped

Emotional:

  • grief valid at any gestation
  • Miscarriage Association, Tommy’s
  • GP — counselling, time off work
  • partner grief too

Trying again

Fertility returns quickly — 1 period often advised for LMP dating

Recurrence risk — ~20% after one loss — still 80% next live birth

Recurrent miscarriage clinic — ≥3 losses — often finds treatable cause

When emergency

  • pad soaked hourly
  • foul discharge, fever — incomplete + infection
  • fainting, severe pain

Miscarriage is common medically, unique personally — early pregnancy unit same day for bleeding, compassion not “just try again” alone.

Common questions about miscarriage

What are the signs of miscarriage?
Vaginal bleeding — light to heavy — cramping lower abdominal pain, passing tissue or clots, loss of pregnancy symptoms sometimes. Some miscarriages discovered on scan without bleeding — missed miscarriage. Ectopic pregnancy causes similar early symptoms — must be excluded with scan.
What causes miscarriage?
Most first trimester losses due to random chromosomal abnormalities in embryo — not preventable. Less commonly — uterine abnormalities, antiphospholipid syndrome, thyroid disease, uncontrolled diabetes, infection. Advanced maternal/paternal age increases risk slightly. Previous miscarriage increases recurrence modestly.
How is miscarriage managed?
Expectant — wait for natural completion if safe. Medical — misoprostol tablets to expedite. Surgical — MVA/ERPC vacuum aspiration under anaesthesia — if incomplete, infected, or preferred. Early pregnancy unit advises best option. Rhesus negative women need anti-D injection after certain events.
How long after miscarriage can I try again?
Physically — ovulation can return within 2 to 4 weeks — many advise waiting one period for dating next pregnancy though evidence allows trying when emotionally ready. No proof waiting improves next outcome unless molar pregnancy or ectopic treatment.
When is recurrent miscarriage investigated?
After 3 consecutive miscarriages (2 in some clinics if maternal age over 40 or no live birth) — tests include antiphospholipid antibodies, thyroid, uterine cavity imaging (hysteroscopy/3D ultrasound), parental karyotypes selected cases, thrombophilia screen debated.

Sources

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