Everything You Need to Know About Miscarriage: Causes, Symptoms and Treatment

Arm yourself with patience and hope, because today we're discussing a sensitive subject: miscarriage. We know that no expectant mother wants to find herself in this situation – and that's precisely why it's important that you're as well informed as possible.

Find out what causes a miscarriage, how it presents itself, how long recovery takes, and how it affects your ability to conceive again in the future.

What is a miscarriage?

The natural and unexpected loss of a pregnancy before the 20th week of gestation is known as a miscarriage (spontaneous abortion). According to statistics, around 10 to 15% of pregnant women experience a miscarriage, and 80% of these pregnancy losses occur in the first trimester. We've covered more about your baby's development in each trimester HERE.

It's a difficult moment and often a genuine trauma for the expectant mother, her family and those close to her. Feelings of guilt frequently come into play too, but the truth is this: in most cases, a miscarriage simply cannot be controlled. It happens because the foetus isn't developing. Psychological support is sometimes needed to process such a loss.

Causes & risk factors for miscarriage

Before we outline the most common causes of miscarriage, we'd like to stress that these aren't within your control. There are, however, risk factors you should be aware of, so you know what you can avoid and what your doctor should be monitoring. These factors include:

• Infections or exposure to certain illnesses
• Hormonal imbalances
• Immune system disorders
• Kidney and heart conditions, thyroid problems or diabetes
• Malformations of the uterus or faulty implantation of the fertilised egg in the uterine lining
• Premature dilation of the cervix
• Severe malnutrition
• Being significantly under- or overweight
• Rhesus incompatibility between mother and baby
• Certain medications
• Smoking
• Alcohol consumption and other harmful substances
• Maternal age that is very young (under 20) or advanced (over 45)
• Radiation
• Excessive stress

In most cases, though, a miscarriage doesn't happen because of something you did (or didn't do) – and that's exactly why it's so difficult to prevent. No woman should feel guilty about a spontaneous pregnancy loss – it simply isn't something you can control.

That said, here are the most common causes of miscarriage:

Causes of miscarriage in the first trimester

In the first trimester, chromosomal abnormalities are the most common cause of miscarriage (in roughly 50% of cases). Chromosomes are the cellular structures that carry genes and determine a child's physical characteristics (such as sex, eye and hair colour, and so on).

At fertilisation, two sets of chromosomes combine. For reasons still unknown, the foetus may end up with too few or too many chromosomes, depending on the chromosome count in the egg or sperm cell. In such cases, the pregnancy doesn't develop normally and the mother experiences a miscarriage.

Other common causes of first-trimester miscarriage include:

• Problems with the placenta
• The mother's age
• Obesity
• Smoking or excessive consumption of coffee, tobacco or other substances

Causes of miscarriage in the second trimester

In the second trimester, miscarriage is usually caused by chronic maternal health conditions. The risk of pregnancy loss increases further if these conditions go untreated. They include hypothyroidism and hyperthyroidism, diabetes, kidney disease and severe arterial hypertension.

A second-trimester miscarriage may also result from the following:

• Infections: HIV, chlamydia, gonorrhoea, syphilis, bacterial vaginosis, malaria or rubella
• Food poisoning: salmonella (often from eating raw or partially cooked eggs), toxoplasmosis (from raw or partially cooked infected meat) or listeriosis (from unpasteurised dairy products such as soft cheeses)
• Certain medications: particularly retinoids (for treating acne), misoprostol (for treating stomach ulcers) or methotrexate (for rheumatoid arthritis)
• Uterine structure: where there are structural problems or malformations, or fibroids
• Cervical insufficiency: as the cervix may open too early
• Polycystic ovary syndrome (PCOS): it's associated with infertility and is therefore considered a possible cause of miscarriage.

Miscarriage – signs and symptoms

With a missed miscarriage, there are no symptoms, and the mother doesn't know she has lost the pregnancy until an ultrasound confirms it.

In all other cases, a spontaneous pregnancy loss may present as follows:

Vaginal bleeding: light at first, but becoming progressively heavier, and it may be accompanied by blood clots and greyish tissue. Bear in mind, though, that bleeding doesn't automatically mean you're losing the pregnancy – we've discussed all the other possible causes in our article on vaginal bleeding during pregnancy.

Abdominal pain: often stronger than period cramps, it may be accompanied by mild to severe pain in the lower back.

Disappearance of pregnancy symptoms: or a noticeable decrease in their intensity.

If you notice any of these symptoms, it's important to see a specialist as soon as possible.

Can a miscarriage be prevented? 

In most cases, a miscarriage cannot be prevented – precisely because it isn't caused by anything the mother does.

The best thing you can do to reduce the likelihood of pregnancy loss as far as possible is to avoid risk factors and look after your body, keeping it in the best possible condition. That means:

• Attend every check-up as advised by your doctor.
• Treat any infections or conditions that could put your pregnancy at risk.
• Maintain a balanced lifestyle and as healthy a diet as possible.
• Keep to a healthy body weight.
• Avoid tobacco, alcohol, excessive coffee consumption and other risky substances.
• Take prenatal vitamins as recommended by your doctor.
• Exercise regularly, at a level suited to your fitness.

Possible diagnoses in miscarriage

Depending on how the pregnancy loss presents and which symptoms accompany it, different types of miscarriage are distinguished. Based on how the pregnancy came to an end, your doctor may give one of the following diagnoses:

Biochemical miscarriage: the diagnosis is made solely on the basis of falling hCG levels, without an ultrasound. This form of pregnancy loss usually occurs in pregnancies achieved through assisted reproductive technologies, within the first 6 weeks.

Missed miscarriage: where the pregnancy has been lost without the patient noticing. This is the form of miscarriage with no other symptoms, confirmed only by ultrasound (which no longer detects the baby's heartbeat).

Complete miscarriage: also confirmed by ultrasound, this describes a miscarriage in which the uterus empties by itself. Symptoms of a complete miscarriage include vaginal bleeding and the passing of foetal tissue.

Incomplete miscarriage: this diagnosis is given when some tissue remains in the uterus after the pregnancy has been lost.

Recurrent miscarriage: this diagnosis is given when a patient has experienced three consecutive spontaneous pregnancy losses. It occurs in 1% of cases and is therefore rare.

Threatened miscarriage: this isn't necessarily a miscarriage, but rather a risk of one. You may receive this diagnosis if you're bleeding and have abdominal pain, but the cervix remains closed. Such a pregnancy can continue perfectly well to term, though it does require close monitoring throughout.

Inevitable (or imminent) miscarriage: this is often followed by a complete miscarriage. It describes a situation in which there is not only bleeding and pain, but the cervix begins to open and amniotic fluid may leak.

Septic miscarriage: this diagnosis is given when the miscarriage is followed by complications from an intrauterine infection. This is a rare situation.

Treating a miscarriage

After a miscarriage, it's important that the foetus and all remaining pregnancy tissue are removed from the uterus to prevent later complications.

If this has happened naturally, no further intervention is needed. Otherwise, if tissue remains in the uterus, your doctor may recommend one of the following approaches:

• Waiting another two weeks for the uterus to expel the foetal tissue naturally. This is usually recommended in cases of incomplete miscarriage.
• Medical treatment, involving medication that opens the cervix and helps the tissue to pass. This is recommended if you don't want to wait, or if tissue is still present after the two weeks have elapsed.
• Surgical treatment by dilation and curettage, meaning the surgical removal of the tissue under general anaesthetic. This is recommended if complications arise or if medical treatment hasn't fully expelled the tissue.

What happens after a miscarriage 

After a miscarriage, mild discomfort along with spotting or light bleeding are normal symptoms. Heavy bleeding, fever, chills and severe pain are not normal and must be reported to your doctor urgently, as they may indicate an infection.

Until the bleeding stops, it's advisable to use hypoallergenic pads made from pure materials. Enroush pads are made exclusively from 100% organic cotton and natural fibres – with no synthetic fibres or chemicals that can increase the risk of irritation and infection. Choose the absorbency you need to feel protected at all times.

You'll also be advised not to insert anything into the vagina for the next two weeks. That means avoiding tampons, sex toys and vaginal sex until your body has fully recovered.

As for life and fertility after a miscarriage: in most cases, neither is physically affected. The risk of another miscarriage is low (under 5%), and it's possible to conceive again as soon as two weeks after such an event.

Frequently asked questions about miscarriage 

But how long does bleeding last after a miscarriage, and how quickly will you recover? How much does it affect your chances of conceiving in the future? You're bound to have plenty of questions like these on your mind – so here are the answers to the most common ones:

How common are miscarriages?

According to statistics, between 10% and 15% of confirmed pregnancies end in miscarriage, and over 80% of these occur in the first trimester.

The mother's age plays a significant role here too. Statistically, miscarriage has been observed in 1 in 10 pregnancies among women under 30, in 2 in 10 pregnancies among women aged 35 to 39, and in 5 in 10 pregnancies among women over 45.

What causes a missed miscarriage? 

A missed miscarriage can have many causes, the most common being genetic problems. The growth and development of the foetus can also be influenced by environmental factors, such as negative emotions experienced by the mother (anxiety, depression, fear, excessive stress and so on).

Why didn't I notice? What are the signs of a missed miscarriage?

It's entirely normal not to have realised you'd lost the pregnancy if you've had a missed miscarriage. By definition, it occurs without symptoms, and the only signs are ones that are usually harmless: spotting, light bleeding or very mild abdominal cramps.

Only a doctor can identify a missed miscarriage – through an ultrasound in which no heartbeat can be detected.

How long does recovery take after a miscarriage?

Most women can resume their normal activities just 1–2 days after the pregnancy tissue has passed naturally or been surgically removed. If complications occurred, full recovery may take 1–2 months. Your doctor will advise you to avoid sexual intercourse and inserting anything into the vagina (including tampons) for 2 weeks.

It's important to know that all of these figures are guidelines, and every woman recovers at her own pace. The emotional toll of a pregnancy loss is considerable, so emotional healing can take far longer than physical healing and may require support from a professional.

Is it difficult to conceive after a missed miscarriage? 

No. In theory, you can conceive again as soon as 2 weeks after a miscarriage, and 87% of women who have been through such an experience have gone on to carry a pregnancy to term and give birth normally. Most miscarriages are caused by a chromosomal abnormality, not by maternal infertility. So the chances of conceiving again are high – even if you've experienced a pregnancy loss.