An early miscarriage is when a pregnancy is lost in the first 3 months. In most cases, there is no known reason why early miscarriages happen. Most commonly, it is thought to be a problem with the baby’s chromosomes (genetic make-up). Less commonly it could be due to hormonal issues or lifestyle factors.
1 in 5 women will have a miscarriage for no apparent reason in the first 3 months, after having a positive pregnancy test. It is usually not related to something that you did or did not do. At 30 years of age, the risk is 1 in 5 (20%); over the age of 40, the risk is 1 in 2 (50%). Other risk factors include poorly controlled medical or lifestyle factors e.g. diabetes, overweight, smoking, drinking alcohol. Stress or having sex in pregnancy is not associated with early miscarriages.
The main sign of an early miscarriage is vaginal bleeding, which may be followed by abdominal cramps in your lower abdomen. However, bear in mind that these symptoms are common during early pregnancy and do not always indicate a miscarriage.
But to be safe, do contact your doctor for further checks if you experience these symptoms.
An early miscarriage is usually diagnosed by a vaginal examination and a transvaginal ultrasound scan. These checks do not increase your risk of having a miscarriage. In some cases, you may be required to do blood tests to check the trend of your pregnancy hormone (b-hcg).
Expectant management means waiting for the miscarriage to happen on its own. Some women feel that this is the most natural form of managing a miscarriage; but it is only suitable for women up to 13 weeks of pregnancy and has a 50% success rate. It may take some time before the bleeding starts, and the bleeding can be prolonged and heavy (up to 3 weeks), associated with abdominal cramps. You will require a follow-up review with your doctor to check that nothing remains in your womb and that expectant management has been successful.
Medical management means taking an oral medication called misoprostrol to allow the pregnancy to come away from the womb. It has a 85% success rate and is used when expectant management isn’t appropriate. You will experience abdominal cramps and bleeding (like a heavy period) few hours after taking the medication, and possibly side effects like fever, diarrhoea and vomiting.
The heavy bleeding should lessen and subside over the next 1-2 weeks. You will require a follow-up review with your doctor to check that nothing remains in your womb and that medical management has been successful.
Washing out the womb under general anaesthesia is successful in 95% of cases. You will be advised to go for this option early if you are having heavy/continuous bleeding, there are signs of infection, or expectant/medical management has been unsuccessful. You will be given either oral or vaginal tablets before the day surgery procedure to soften the cervix. This operation is safe and commonly done, although there is a small risk of complications which your doctor will advise you on.
After your bleeding settles (which typically takes about 1-2 weeks), your next period will usually come in 4-6 weeks’ time. The earliest time to try for your next pregnancy is after 1 normal period (do use birth control if you are not planning to get pregnant so soon).
A miscarriage affects every woman and her partner differently, so do ensure that you allow yourself time to grieve and get support from your family and friends. You may return to work after your medical leave. You can resume sex and/or try for your next baby as soon as you and your partner feel ready.
Please contact your doctor if you:
If you have had 1 or 2 early miscarriages, you are not at a higher risk of another miscarriage. Most early miscarriages are a once-off event and you have a good chance of having a successful pregnancy in the future. Do remember to take folic acid before you start trying for your next pregnancy, and maintain a healthy lifestyle.
If you have had 2 or 3 miscarriages (depending on your age), you may have a condition that puts you at increased risk of having a miscarriage. Do speak to your doctor about further checks if this is so.
