Everything you need to know about miscarriages and why they happen

One writer on what she wish she knew before suffering a miscarriage

Words by Amie Duxbury

Amie Duxbury writes about miscarriage and her life as a mum at two-lines.blog

Miscarriage occurs more often than people realise – one in four pregnancies end in miscarriage, the majority of these will occur before a woman has announced her pregnancy and as such can be an incredibly lonely time.

It is also a topic which is seldom discussed openly and therefore those suffering generally have many questions. I’m writing this because we need to talk about miscarriage, namely the signs of miscarriage, causes of miscarriage, as well as some detail on the incidence of the continuation of a successful pregnancy week upon week.

What is a miscarriage?

A miscarriage is the loss of a pregnancy up to 23 weeks. Loss prior to 13 weeks is termed an early miscarriage; miscarriage between 14 and 23 weeks is termed late miscarriage & much less common. A loss from 24 weeks is classed as a stillbirth.

Signs of miscarriage

Signs of miscarriage commonly reported are blood loss, vaginal discharge, pain and a loss of previously held pregnancy symptoms.

Bleeding during pregnancy

The most reported sign of miscarriage is blood loss – however not all bleeding in pregnancy is linked to miscarriage. Bleeding in pregnancy can occur as an implantation bleed (when the egg implants in the wall of the uterus, typically around the time of the missed period). Bleeding can also be due to hormonal changes in the cervix. Blood can be brown (generally an indication of old blood) pink or red. If the bleeding persists, is accompanied with pain in your back or stomach and/or the blood loss increases and resembles a period then you need to seek medical attention either from your GP or an Early Pregnancy Unit.

If you are soaking through pads in a matter of hours then call 111 for immediate advice. If the bleeding is accompanied by persistent and severe abdominal pain, generally on one side, pain in the tip of your shoulder, diarrhoea and vomiting or feeling faint and light-headed then treat it as a medical emergency as these are symptomatic of an ectopic pregnancy (where the egg implants outside of the womb). Ectopic pregnancy symptoms usually appear between 5 and 14 weeks of pregnancy.

Vaginal discharge

Vaginal discharge or the passing of any matter is also a sign of miscarriage. A slight increase in your vaginal discharge in early pregnancy is normal, however if the discharge is blood-tinged then treat this as a bleed and take advice as per bleeding in early pregnancy. If the discharge is an unusual colour (not clear or milky) and/or has a strange odour then this could be a sign of infection and you should seek medical attention.

Pain

Pain or discomfort in early pregnancy can be caused by ligaments stretching or hormonal changes. Some women experience period-like pain in their stomach or back in early pregnancy. However pains that feel like intense period pain, are unrelenting, one-sided or accompanied by bleeding then seek medical attention.

Loss of pregnancy symptoms

Some women have reported suddenly feeling ‘not pregnant’. It may be that you lose symptoms of pregnancy that were previously present – for example no longer experiencing morning sickness or your breasts no longer being sore.

In some instances, there are no signs of miscarriage and the incidence of the miscarriage will be picked up at the routine anomaly scan. This is termed a missed miscarriage.

Many hospitals have an Early Pregnancy Unit (EPU) and this is typically where you will be seen if you have symptoms of an early miscarriage. Information around EPUs and detail of the one closest to you can be found here.

Although miscarriage and in particular early miscarriage is common, repeated miscarriage affects only approximately 1 in 100 women. Three incidences of miscarriage is classed as repeated miscarriage and in these cases, support is often available to assist in an attempt to find any causes for the losses. Medication may help a pregnancy to be maintained, under the care of a specialist. The majority of miscarriages, however, are a one-off event and women will go on to have successful pregnancies without intervention.

Causes of Miscarriage

There can be many causes of miscarriage and generally the cause will not be identified. Miscarriages within the first trimester are typically caused by a problem with the chromosomes of the foetus. Later miscarriages can be caused by underlying health conditions of the mother, issues with the placenta, a weakness in the neck of the cervix or an infection.

There are factors that can increase your risk of miscarriage; age – a thirty year old has a 20% chance of miscarriage, increasing to around 40% in your forties. Other factors include obesity, smoking or drug use, drinking more than 200mg of caffeine a day, drinking more than two units of alcohol a week.  Some long term health conditions can also increase your risk of late miscarriage, these include poorly managed diabetes, severely high blood pressure, thyroid issues, kidney disease, lupus and sexually transmitted infections such as HIV, chlamydia and gonorrhoea.

Miscarriage Risk By Week

Your risk of early miscarriage decreases once a heartbeat has been detected – a heartbeat can often be detected on an early scan at around six or seven weeks. The incidence of miscarriage has been found to decrease from six to ten weeks, once a heartbeat has been detected. A study from 2003 printed in the Journal of Obstetrics & Gynaecology on 668 women, showed that the incidence of miscarriage decreased week on week but this is offset by a woman’s age. At fourteen weeks the chance of miscarriage in a healthy woman drops to around 1%. Despite web searches providing you with various percentages of risk by week, there is not any definitive information around the percentage risk of miscarriage by week.

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