Signs and Symptoms of Miscarriage
(Spontaneous Abortion)

Miscarriage refers to a pregnancy that ends at any period during the first twenty weeks of pregnancy. The medical term for miscarriage is spontaneous abortion. While a miscarriage usually resolves without physical complications, women often experience emotional complications such as anger, grief and depression.
Spontaneous Abortion Incidence Rates
Between twenty and fifty percent of pregnancies end in miscarriage. The vast majority of spontaneous abortion cases occur during the early weeks of the pregnancy. In most cases, signs of miscarriage during the initial stages of pregnancy are undetectable, and the woman may not even be aware she was pregnant, or that she had a miscarriage.

Once pregnancy is detected, approximately ten percent end in miscarriage. Most diagnosed miscarriages occur during the seventh to twelfth weeks of pregnancy.

Causes of Spontaneous Abortion

Most miscarriages occur without a known cause. Complications and defects in the chromosomal development of the fetus cause up to seventy percent of spontaneous abortion cases.

Other complications that may cause miscarriage include infections, trauma and certain systemic diseases, including diabetes and antiphospholipid syndrome (APS). Women with anatomical abnormalities such as uterine fibroids are at a higher risk of spontaneous abortion.

Some causes of miscarriage during pregnancy can be avoided. The risk of a miscarriage is heightened by smoking, drug abuse or alcohol abuse during pregnancy. Avoiding these substances reduces the risk of spontaneous abortion. Exercise and sexual intercourse do not cause spontaneous abortion.

Miscarriages During the Second Trimester

Most miscarriages occur during the first trimester, but can occur during the second trimester. Physical complications such as uterine or cervical abnormalities account for some second trimester miscarriages. Fetal chromosome complications and complications due to immune system disorders may also cause miscarriage during the second trimester.

Signs of Miscarriage: Spotting, Bleeding and Cramps

Signs of miscarriage vary, depending on when the miscarriage occurs. A miscarriage during the initial weeks of pregnancy often has few or no symptoms. The most common signs of miscarriage include vaginal spotting, bleeding and cramps. Most early miscarriages are mistaken for a heavy menstrual period.

Additional signs of miscarriage include symptoms such as low back pain and abdominal pain. While vaginal bleeding and spotting are common, women may also experience fluid leaking from the vagina, or they may pass tissue or "clotty" material through the vagina. All such symptoms are possible signs of miscarriage. Any tissue or material passed during a spontaneous abortion should be taken to your doctor for examination.

Twenty percent of women have some degree of spotting or bleeding in the first trimester. Not every woman who has spotting or bleeding will have a miscarriage. However, as spotting and bleeding are possible signs of miscarriage, these symptoms should be reported to your doctor.

Treatment During Symptoms

A miscarriage may be prevented if signs are detected early enough. A "threatened" pregnancy refers to a case where signs of a potential miscarriage exist, but it has not actually occurred. Activities may be restricted during suspicious symptoms, with complete bed rest recommended when needed. Sexual activity is not advised until symptoms disappear.

Complications of Miscarriage

Spontaneous abortions typically do not cause physical complications. In most cases, a woman recovers physically within a few months. However, when dead tissue from the miscarriage remains in the womb, infections may occur. In this case, a D & C (dilation and curettage), or uterine scraping, is performed to remove the remaining tissue.

Emotional Complications

While physical complications from miscarriages are uncommon, the emotional complications in the weeks following a spontaneous abortion can be severe. Women and their partners often feel grief, guilt and anger over the miscarriage and the loss of their unborn child. Severe complications can include depression.

Planning a Pregnancy After a Miscarriage

After a spontaneous abortion, couples should wait a few months before trying to get pregnant again. Not only does this give the woman time to recover from any physical complications, it also gives her time to recover from the emotional complications of the miscarriage.

If a woman suffers multiple spontaneous abortions, testing may be required before and during pregnancy to determine why miscarriages are occurring.

Resources

Beers, M. H., & Berkow, R., eds. (1999). Normal pregnancy, labor, and delivery. The Merck Manual of Diagnosis and Therapy, 17th Edition. NJ: Merck Research Laboratories.

Callahan, T. L., Caughey, A. B., & Heffner, L. J. (2001). Blueprints in Obstetrics and Gynecology, 2nd Edition. MA: Blackwell Publishing.

March of Dimes Birth Defects Foundation. (2000). Miscarriage.

Torpy, J. (2002). JAMA patient page: Miscarriage.

U.S. National Library of Medicine. (updated 2004). Abortion: Spontaneous. MedlinePlus Medical Encyclopedia.