10 Things You Didn't Know About Miscarriages

miscarriage is a pregnancy loss that takes place within the first 20 weeks of gestation, with the vast majority occurring within the first trimester (the first 12 weeks of pregnancy). While miscarriage is fairly common, it's a process that can be painful for the mother, both physically and emotionally. 

The following are 10 things that are important to know if you are having symptoms of a miscarriage or have been recently diagnosed with a miscarriage.

1
Pregnancy Bleeding Does Not Always Mean Miscarriage

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Miscarriages can be devastating regardless of the cause or when they occur in the pregnancy. Beyond abdominal cramping and passing tissues (the placenta and the gestational sac) through the vagina, one of the most common symptoms of miscarriage is vaginal bleeding. That said, bleeding in early pregnancy does not always mean miscarriage. 

The only way to know for sure if your bleeding is from a miscarriage is through an evaluation with your doctor. If your doctor determines you are indeed experiencing a miscarriage, it's important to roughly measure how much you're bleeding. If the blood is soaking through two maxi pads per hour for two consecutive hours, call your doctor right away. This may be a sign that you are hemorrhaging, and you may need a procedure called a dilation and curettage (D&C) to stop the bleeding. 

If you are not bleeding that heavily but are concerned that your bleeding seems to be persisting for too long—like if you have had heavy bleeding for more than two or three days—it is a good idea to see your doctor to rule out complications.

2
Miscarriage Diagnosis May Take up to a Week

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Sometimes doctors can diagnose a miscarriage before the symptoms actually begin. For instance, during early pregnancy, a doctor will give you a blood test that checks your level of human chorionic gonadotropin (hCG), a hormone that's produced during pregnancy. If that level is not doubling every two to three days in the first trimester or it is dropping, that is, unfortunately, a telltale sign of an impending miscarriage.

Even if you are having symptoms of a miscarriage, doctors often cannot confirm a miscarriage in a single day. You may need to have at least two blood tests measuring human chorionic gonadotropin (hCG) and/or ultrasound scans days apart in order for the doctor to get enough information to determine whether the pregnancy is developing properly or not.

3
The Emergency Room Is Not Always the Best Place to Go When Having Symptoms

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In the first trimester, a doctor can't do anything to stop a miscarriage that is in progress, and as stated above, you may not be able to get a diagnosis during a single visit anyway.

Of course, seek out emergent medical attention if you are worried about any of the following situations:

  • You are concerned about an ectopic pregnancy
  • Your bleeding is extremely heavy (soaking a menstrual pad in under an hour)
  • You have any concern that your health is otherwise at risk.

But absent those concerns, the ER probably won't be able to do much for you, so it's best to call your regular doctor.

4
An Ectopic Pregnancy Is Not Always a Medical Emergency

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It is absolutely true that an ectopic pregnancy is sometimes a medical emergency, as a ruptured ectopic pregnancy can be fatal. But when doctors diagnose an ectopic pregnancy early enough along that it doesn't seem at risk of rupture, the situation may not be so dire. The treatment may be a medication to end the pregnancy on an outpatient basis, or simply monitoring the hCG levels if it appears that the ectopic pregnancy is ending naturally.

5
It's Possible to Miscarry With No Symptoms

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Sometimes the baby stops growing and developing, but there are no outward signs of miscarriage like cramping, bleeding, or the passage of tissue. This is called a missed miscarriage.

In this instance, the pregnancy loss is often discovered incidentally during a routine ultrasound or when the heartbeat fails to become audible on a handheld doppler by the start of the second trimester

Once diagnosed with a missed miscarriage, a woman and her doctor will decide how to proceed with the miscarriage. For instance, a woman may decide to have a natural miscarriage, which means she waits for the symptoms to begin and the fetal tissue to pass on its own. Other women prefer an intervention, either taking a medication or having a D&C.

6
The Physical Process of Miscarriage Can Take Several Days

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Despite how it is often depicted in the media, a first-trimester miscarriage usually does not happen all at once. The baby usually has already passed away by the time the physical symptoms of miscarriage appear, sometimes more than a week before. The miscarriage bleeding may begin as light spotting and then progress to a heavier flow with clots after a few days. You may have some level of bleeding for up to two weeks, although it should not remain heavy for that entire time.

All in all, the precise timing of how long a miscarriage lasts is fairly unique for each woman, as it depends on a couple factors. For instance, in one scenario, a woman might start bleeding a few hours after getting the diagnosis and, in another scenario, the miscarriage process might not begin for several weeks, even if the pregnancy is not viable.

That said, research shows that you're most likely to start and finish bleeding within two weeks of the diagnosis.

It's also important to note that after a miscarriage diagnosis, a woman may opt to manage her miscarriage medically or surgically (for example, a D&C), and this also affects the duration of symptoms. For example, after a D&C to manage a miscarriage, a woman may experience light bleeding or mild discomfort, but not heavy bleeding or abdominal pain. If this happens, a woman should contact her doctor right away.

7
A Natural Miscarriage Can Involve Severe Cramping

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Many people describe an early miscarriage as being like a heavy menstrual period. For some women, the reality is that the process involves more than just minor cramps. There can be intense lower abdominal/back pain that interferes with your ability to go about normal daily activities.

Check with a doctor when you have severe cramping to be sure that ectopic pregnancy is ruled out, and perhaps to get a recommendation for a painkiller. But severe pain with a miscarriage does not necessarily mean anything abnormal is going on.

8
Your Fertility May Return Right Away—or It Might Not

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Some women will resume ovulating in as little as two weeks after a miscarriage, whereas others may find themselves waiting up to three months before normal menstrual cycles resume. There is a lot of individual variation and it is not possible to predict when you will be fertile again. So it's a good idea to use protection anytime you have sex unless you are trying to get pregnant again.

9
You Might Not Really Need to Wait to Try Again

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Doctors sometimes recommend waiting for various amounts of time before getting pregnant again after a miscarriage, but barring individual medical circumstances, there is no strong evidence that there are any increased risks if you get pregnant again right away.

10
Reasons for Miscarriage Are Not Well Understood

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It's easy to assume that modern medicine has all the answers, but unfortunately, that's just not the case. Sometimes even reputable sources will have conflicting information about what does and doesn't cause miscarriage. Frustratingly often, there are simply more questions than answers—and that can be hard to accept.

A Word From Verywell

It's important to mention that in addition to the physical symptoms of a miscarriage like vaginal bleeding, it's common to experience emotional distress. What complicates matters is that others often don’t view it as a loss and tell you “it was for the best” or that you can try again.

If you are experiencing a miscarriage, instead of keeping your thoughts and feelings bottled up, ask your doctor if there is a support group in your town or a therapist you can see.

Privately talking to other women who have been through the same experience or seeking help from a healthcare professional who has experience working with women who have had a miscarriage may help you cope with the heartbreaking loss and feel less alone.

Sources:

American College of Obstetrics and Gynecology. (August 2015). Frequently Asked Questions: Early Pregnancy Loss.

American College of Obstetrics and Gynecology. (May 2015).  Practice Bulletin: Early Pregnancy Loss.

American College of Obstetricians and Gynecologists (February 2016). Dilation and Curettage. 

American Pregnancy Association (August 2016). Miscarriage: Signs, Symptoms, Treatment And Prevention. ​​

Hillard, Paula Adams. The 5-Minute Obstetrics and Gynecology Consult. Lippincott Williams & Wilkins, 2008. Page 588.

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