7 things to know about miscarriage: Causes and symptoms & what happens next

Understanding miscarriage types, causes for miscarriage and how we make the diagnosis

In this post, we will cover; 

1. What is a miscarriage?
2. How common are miscarriages?
3. Symptoms
4. Diagnosis
5. Types of miscarriage
6. What contributes to a miscarriage (and what does not)
7. Can testing help determine the cause of a miscarriage?

1. What is a Miscarriage?

A miscarriage, also known as a pregnancy loss, is the heartbreaking experience of losing a pregnancy before 20 weeks of gestation. After 20 weeks, pregnancy loss is referred to as a stillbirth. While the term “abortion” is sometimes used in medical contexts, we recognize that it can be distressing for those grieving a pregnancy loss. That’s why many prefer to use the term “miscarriage,” which acknowledges the emotional weight of this particular experience.

2. How Common Are Miscarriages?

Miscarriages are far more common than many people realize. Studies suggest that 10-20% of recognized pregnancies end in miscarriage (Sources: PubMD, PubMD), though the actual number is likely higher, as many losses occur before a person even knows they are pregnant. While statistics provide context, we know that each loss is deeply personal and significant.

3. Recognizing the Signs of a Miscarriage

Symptoms of miscarriage vary greatly, and some may experience no symptoms at all. Others may notice:

• Vaginal bleeding (from light spotting to heavier bleeding with clots)
• Cramping or pain (often described as severe menstrual cramps)
• Lower back discomfort
• Passing grayish-colored tissue
• A decrease in pregnancy symptoms (though this alone is not always a cause for concern)

Some individuals may experience a missed miscarriage, where the pregnancy stops developing, but the body does not immediately recognize the loss. This can make the experience even more difficult, as there may be no warning signs.

4. How is a Miscarriage Diagnosed?

A miscarriage is typically confirmed through a combination of ultrasound and blood tests:

• Ultrasound: Determines if a pregnancy is progressing as expected and checks for a heartbeat.
• hCG Levels (Pregnancy Hormone Test): A decline in levels over time may indicate a miscarriage.
• Blood Type Screening: Determines whether Rh immunoglobulin (RhoGAM) is needed to prevent complications in future pregnancies.

5. Different Types of Miscarriages

Every pregnancy loss is unique, but healthcare providers use certain terms to describe different types of miscarriages:

• Complete Miscarriage: The body has naturally passed all pregnancy tissue.
• Incomplete Miscarriage: Some pregnancy tissue remains and may require medical support.
• Missed Miscarriage: The pregnancy stops developing, but the body has not yet recognized the loss.
• Threatened Miscarriage: Bleeding or cramping occurs, but the pregnancy continues with a detected heartbeat.
• Septic Miscarriage: A rare but serious miscarriage accompanied by an infection.
• Recurrent Miscarriage: Defined as multiple pregnancy losses, which may signal an underlying condition.

6. What Contributes to a Miscarriage?

Many factors can contribute to pregnancy loss, and it’s important to emphasize that most miscarriages are not caused by anything you did or didn’t do. Some of the most common reasons include: 

• Genetic Factors: Over 50% of miscarriages result from random chromosomal abnormalities that prevent the embryo from developing properly.
• Maternal Age: The risk of miscarriage increases as the egg provider’s age rises:
  • Under 30: ~10-12%
  • 32-34: ~12-15%
  • 35-39: ~15-20%
  • 40-44: ~30-40%
  • 45+: 50%+

Source: PubMD

• Underlying Health Conditions: Conditions such as diabetes, thyroid disorders, or autoimmune diseases can increase the risk of pregnancy loss.
• Structural Uterine Differences: Certain uterine conditions, such as fibroids or a uterine septum, can impact pregnancy.
• Environmental and Lifestyle Factors: While excessive smoking, alcohol, or exposure to toxins may raise the risk, everyday activities such as exercise, lifting objects, or experiencing stress do not cause miscarriage.

What Does NOT Cause a Miscarriage?

After experiencing a pregnancy loss, it’s natural to wonder if something could have been done differently. Please know that certain common worries are not causes of miscarriage:

• Exercise and sexual activity
• Lifting everyday objects or using stairs
• Experiencing stress or emotional distress
• Missing a prenatal vitamin dose
• Eating certain foods (unless a severe infection occurs, such as listeriosis)
• Having an alcoholic drink before knowing you were pregnant

7. Can Testing Help Determine the Cause of a Miscarriage?

In some cases, genetic testing of pregnancy tissue (products of conception (POC) testing) can provide answers. Two types of tests exist:

1. Tissue Testing: Requires collecting pregnancy tissue for chromosomal analysis.
2. Non-Invasive Blood Testing: Detects fetal DNA in the bloodstream but can only be done before vaginal bleeding begins.

These tests can be costly (approximately $600) and are not always covered by insurance. While they cannot change the past, they may help provide emotional closure or guide next steps for future pregnancies.

If you have experienced a miscarriage, please know that you are not alone, and this is not your fault. Pregnancy loss can be physically and emotionally difficult, and grieving is a personal journey. Most people who experience a miscarriage go on to have a healthy pregnancy in the future, and support is available for those who need it. The bottom line is that the vast majority of miscarriages have nothing to do with something that you did or something that you didn’t do.  

If you found this information helpful, stay tuned for Part 2, where we will discuss options for miscarriage management and what to expect moving forward. Remember, you are not alone on this journey.