Overview

Symptoms

Who can get it

There are many reasons why a miscarriage may happen, although the cause is often not identified.

If a miscarriage happens during the first trimester of pregnancy (the first 3 months), it's usually caused by problems with the unborn baby (foetus). About 3 in every 4 miscarriages happen during this period.

If a miscarriage happens after the first trimester of pregnancy, it may be the result of things like an underlying health condition in the mother.

These late miscarriages may also be caused by an infection around the baby, which leads to the bag of waters breaking before any pain or bleeding. Sometimes they can be caused by the neck of the womb opening too soon.

First trimester miscarriages

First trimester miscarriages are often caused by problems with the chromosomes of the foetus.

Chromosome problems

Chromosomes are blocks of DNA. They contain a detailed set of instructions that control a wide range of factors, from how the cells of the body develop to what colour eyes a baby will have.

Sometimes something can go wrong at the point of conception and the foetus receives too many or not enough chromosomes. The reasons for this are often unclear, but it means the foetus will not be able to develop normally, resulting in a miscarriage.

This is very unlikely to recur. It does not necessarily mean there's any problem with you or your partner.

Placental problems

The placenta is the organ linking the mother's blood supply to her baby's. If there's a problem with the development of the placenta, it can also lead to a miscarriage.

Things that increase your risk

An early miscarriage may happen by chance. But there are several things known to increase your risk of problems happening.

The age of the mother has an influence:

• in women under 30, 1 in 10 pregnancies will end in miscarriage
• in women aged 35 to 39, up to 2 in 10 pregnancies will end in miscarriage
• in women over 45, more than 5 in 10 pregnancies will end in miscarriage

A pregnancy may also be more likely to end in miscarriage if the mother:

• is obese
• smokes
• uses drugs
• has lots of caffeine
• drinks alcohol

Second trimester miscarriages

Long-term health conditions

Several long-term (chronic) health conditions can increase your risk of having a miscarriage in the second trimester, especially if they’re not treated or well controlled.

These include:

• diabetes (if it's poorly controlled)
• severe high blood pressure
• lupus 
• kidney disease 
• an overactive thyroid gland
• an underactive thyroid gland
• antiphospholipid syndrome (APS)

Infections

The following infections may also increase your risk:

• rubella (german measles)
• cytomegalovirus
• bacterial vaginosis
• HIV
• chlamydia
• gonorrhoea 
• syphilis 
• malaria 

Food poisoning

Food poisoning, caused by eating contaminated food, can also increase the risk of miscarriage. For example:

• listeriosis – most commonly found in unpasteurised dairy products, such as blue cheese
• toxoplasmosis – which can be caught by eating raw or undercooked infected meat
• salmonella – most often caused by eating raw or partly cooked eggs

Read more about foods to avoid in pregnancy.

Medicines

Medicines that increase your risk include:

• misoprostol – used for conditions such as rheumatoid arthritis
• retinoids – used for eczema and acne
• methotrexate – used for conditions such as rheumatoid arthritis
• non-steroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen; these are used for pain and inflammation

To be sure a medicine is safe in pregnancy, always check with your doctor, midwife or pharmacist before taking it.

Read more about medicines during pregnancy.

Womb structure

Problems and abnormalities with your womb can also lead to second trimester miscarriages. Possible problems include:

• non-cancerous growths in the womb called fibroids
• an abnormally shaped womb

Weakened cervix

In some cases, the muscles of the cervix (neck of the womb) are weaker than usual. This is known as a weakened cervix or cervical incompetence.

A weakened cervix may be caused by a previous injury to this area, usually after a surgical procedure. The muscle weakness can cause the cervix to open too early during pregnancy, leading to a miscarriage.

Polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a condition where the ovaries are larger than normal. It's caused by hormonal changes in the ovaries.

PCOS is known to be a leading cause of infertility as it can lower the production of eggs. There's some evidence to suggest it may also be linked to an increased risk of miscarriages in fertile women.

Misconceptions about miscarriage

An increased risk of miscarriage is not linked to:

• a mother's emotional state during pregnancy, such as being stressed or depressed
• having a shock or fright during pregnancy
• exercise during pregnancy – but discuss with your GP or midwife what type and amount of exercise is suitable for you during pregnancy
• lifting or straining during pregnancy
• working during pregnancy – or work that involves sitting or standing for long periods
• having sex during pregnancy
• travelling by air
• eating spicy food

Recurrent miscarriages

Many women who have a miscarriage worry they'll have another if they get pregnant again. But most miscarriages are a one-off event.

About 1 in 100 women experience recurrent miscarriages (3 or more in a row) and many of these women go on to have a successful pregnancy.

Diagnosis

If you see your GP or midwife because of vaginal bleeding or other symptoms of miscarriage, you may be referred to an early pregnancy unit at a hospital for tests.

If you're more than 18 weeks pregnant, you'll usually be referred to the maternity unit at the hospital.

If you're less than 6 weeks pregnant, you may not be referred for tests straight away. This is because it's very hard to confirm a miscarriage this early on.

Tests

The hospital can carry out tests to confirm whether you're having a miscarriage. The tests can also confirm whether there's still some pregnancy tissue left in your womb (an incomplete or delayed miscarriage) or if all the pregnancy tissue has been passed out of your womb (a complete miscarriage).

The first test used is usually an ultrasound scan to check the development of your baby and look for a heartbeat. In most cases, this is usually carried out using a small probe inserted into the vagina (transvaginal ultrasound). This can feel a little uncomfortable but is not painful.

You may be able to have an external scan through your tummy if you prefer, although this method reduces the accuracy of the scan. Neither type of scan is dangerous to the baby and they do not increase your risk of miscarriage.

You may also be offered blood tests to measure hormones associated with pregnancy. You usually need to have 2 blood tests 48 hours apart to see if your hormone levels go up or down.

Sometimes a miscarriage cannot be confirmed immediately using ultrasound or blood testing. If this is the case, you may be advised to have the tests again in 1 or 2 weeks.

Recurrent miscarriages

If you've had 3 or more miscarriages in a row (recurrent miscarriages), further tests are often used to check for any underlying cause. However, no cause is found in about half of cases. 

If you become pregnant, most units offer an early ultrasound scan and follow-up in the early stages to reassure and support parents.

Karyotyping

If you've had a third miscarriage, it's recommended that the foetus is tested for abnormalities in the chromosomes (blocks of DNA).

If a genetic abnormality is found, you and your partner can also be tested for abnormalities with your chromosomes that could be causing the problem. This type of testing is known as karyotyping.

If karyotyping detects problems with your or your partner's chromosomes, you can be referred to a clinical geneticist (gene expert).

They'll be able to explain your chances of a successful pregnancy in the future and whether there are any fertility treatments, such as  (IVF), that you could try. This type of advice is known as genetic counselling.

Read more about genetic testing and counselling. 

Ultrasound scans

A transvaginal ultrasound can be used to check the structure of your womb for any abnormalities. A second procedure may be used with a 3D ultrasound scanner to study your lower tummy and pelvis to provide a more accurate diagnosis.

The scan can also check if you have a weakened cervix. This test can usually only be carried out when you become pregnant again, in which case you'll usually be asked to come for a scan when you are between 10 and 12 weeks pregnant.

Blood testing

Your blood can be checked for high levels of the antiphospholipid (aPL) antibody and lupus anticoagulant. This test should be done twice, a few weeks apart, when you're not pregnant.

These aPL antibodies are known to increase the chance of blood clots and change the way the placenta attaches. These blood clots and changes can reduce the blood supply to the foetus, which can cause a miscarriage.

Missed or delayed miscarriage

Sometimes a miscarriage is diagnosed during a routine scan carried out as part of your antenatal care. A scan may reveal your baby has no heartbeat or that your baby is too small for the date of your pregnancy. This is called a missed or delayed miscarriage.

What happens?

If there's no pregnancy tissue left in your womb, no treatment is required.

However, if there's still some pregnancy tissue in your womb, your options are:

• expectant management – wait for the tissue to pass out of your womb naturally
• medical management – take medicine that causes the tissue to pass out of your womb
• surgical management – have the tissue surgically removed

The risk of complications is very small for all these options. It's important to discuss them all with the doctor in charge of your care.

Expectant management

If you have a miscarriage in your first trimester, you may choose to wait 7 to 14 days after a miscarriage for the tissue to pass out naturally. This is called expectant management.

If the pain and bleeding have lessened or stopped completely during this time, this usually means the miscarriage has finished. You should be advised to take a home pregnancy test after 3 weeks.

If the test shows you're still pregnant, you may need to have further tests.

If the pain and bleeding have not started within 7 to 14 days or are continuing or getting worse, this could mean the miscarriage has not begun or has not finished. In this case, you should be offered another scan.

After this scan, you may decide to either continue waiting for the miscarriage to occur naturally, or have drug treatment or surgery. If you choose to continue to wait, your healthcare professional should check your condition again up to 14 days later.

Contact your hospital immediately if the bleeding becomes particularly heavy, you develop a high temperature (fever) or you experience severe pain.

Medicine

You may choose to have medicine to remove the tissue if you do not want to wait, or if it does not pass out naturally within 2 weeks. This involves taking tablets that cause the cervix to open, allowing the tissue to pass out.

In most cases, you'll be offered tablets called pessaries that are inserted directly into your vagina, where they dissolve.

The tablets usually begin to work within a few hours. You'll experience symptoms similar to a heavy period, such as cramping and heavy vaginal bleeding. You may also experience vaginal bleeding for up to 3 weeks.

In most units, you'll be sent home for the miscarriage to complete. This is safe, but ring your hospital if the bleeding becomes very heavy.

You should be advised to take a home pregnancy test 3 weeks after taking this medicine. If the pregnancy test shows you're still pregnant, you may need to have further tests.

You may be advised to contact your healthcare professional to discuss your options if bleeding has not started within 24 hours of taking the medicine.

Surgery

In some cases, surgery is used to remove any remaining pregnancy tissue. You may be advised to have immediate surgery if:

• you experience continuous heavy bleeding
• there's evidence the pregnancy tissue has become infected
• medicine or waiting for the tissue to pass out naturally has been unsuccessful

Surgery involves removing any remaining tissue in your womb with a suction device. You should be offered a choice of general anaesthetic or local anaesthetic if both are suitable.

After a miscarriage

A miscarriage can be very upsetting, and you and your partner may need counselling or support. You may also have questions about trying for another baby and what happens to the miscarried foetus.

Afterwards

A miscarriage can have a profound emotional impact, not only on the woman herself, but also on her partner, friends and family.

Advice and support is available during this difficult time.

Remembrance 

It's usually possible to arrange a memorial and burial service if you want one. In some hospitals or clinics, it may be possible to arrange a burial within the grounds.

You can also arrange to have a burial at home, although you may need to consult your local authority before doing so.

Cremation is an alternative to burial and can be performed at either the hospital or a local crematorium. However, not all crematoriums provide this service and there will not be any ashes for you to scatter afterwards.

You do not need to formally register a miscarriage. However, some hospitals can provide a certificate to mark what has happened if you want one.

Emotional impact

Sometimes the emotional impact is felt immediately after the miscarriage, whereas in other cases it can take several weeks. Many people affected by a miscarriage go through a bereavement period.

It's common to feel tired, lose your appetite and have difficulty sleeping after a miscarriage. You may also feel a sense of guilt, shock, sadness and anger – sometimes at a partner, or at friends or family members who have had successful pregnancies.

Different people grieve in different ways. Some people find it comforting to talk about their feelings, while others find the subject too painful to discuss.

Some women come to terms with their grief after a few weeks of having a miscarriage and start planning for their next pregnancy. For other women, the thought of planning another pregnancy is too traumatic, at least in the short term.

The father of the baby may also be affected by the loss. Men sometimes find it harder to express their feelings, particularly if they feel their main role is to support the mother and not the other way round. It may help to make sure you openly discuss how both of you are feeling.

Miscarriage can also cause feelings of anxiety or depression, and can lead to relationship problems.

Getting support

If you're worried that you or your partner are having problems coping with grief, you may need further treatment and counselling. There are support groups that can provide or arrange counselling for people who have been affected by miscarriage.

Read more about dealing with loss and counselling, and find bereavement support services in your area.

Your GP can provide you with support and advice. The following organisations can also help:

• The Miscarriage Association is a charity that offers support to people who have lost a baby. They have a helpline (01924 200 799, Monday to Friday, 9am to 4pm) and an email address (info@miscarriageassociation.org.uk), and can put you in touch with a support volunteer.
• Cruse Bereavement Care helps people understand their grief and cope with their loss. They have a helpline (0808 808 1677, Monday to Friday, 9:30am to 5pm) and a network of local branches where you can find support.

When can I have sex again after a miscarriage?

You should avoid having sex until all of your miscarriage symptoms have gone. Your periods should return within 4 to 8 weeks of your miscarriage, although it may take several months to settle into a regular cycle.

If you do not want to get pregnant, you should use contraception immediately. If you do want to get pregnant again, you may want to discuss it with your GP or hospital care team. Make sure you are feeling physically and emotionally well before trying for another pregnancy.

The Miscarriage Association has information on Thinking about another pregnancy that you may find helpful. It's important to remember that most miscarriages are a one-off and are followed by a healthy pregnancy.

Although it's not usually possible to prevent a miscarriage, there are some ways you can reduce the risk.

Finding a cause

It's natural to want to know why a miscarriage happened, but unfortunately this is not always possible. Many miscarriages are thought to be caused by a one-off problem with the development of the foetus.

Prevention

In many cases, the cause of a miscarriage is not known and you would not have been able to prevent it.

However, there are ways to lower your risk of miscarriage, including:

• not smoking during pregnancy
• not drinking alcohol or using illegal drugs during pregnancy
• eating a healthy, balanced diet with at least 5 portions of fruit and vegetables a day
• making attempts to avoid certain infections during pregnancy, such as rubella
• avoiding certain foods during pregnancy, which could make you ill or harm your baby
• being a healthy weight before getting pregnant

Your weight

Obesity increases your risk of miscarriage. A person is obese when they have a body mass index (BMI) of over 30. You can check your BMI using the healthy weight calculator. If you're pregnant, your midwife or doctor may be able to tell you your BMI.

The best way to protect your health and your baby's wellbeing is to lose weight before you become pregnant. By reaching a healthy weight, you cut your risk of all the problems associated with obesity in pregnancy. Contact your GP for advice about how to lose weight. They may be able to refer you to a specialist weight loss clinic.

As yet, there's no evidence to suggest losing weight during pregnancy lowers your risk of miscarriage, but eating healthily, and activities such as walking and swimming, are good for all pregnant women.

If you were not active before becoming pregnant, you should consult your midwife or doctor before starting a new exercise regimen while you're pregnant.

Read more about obesity and pregnancy and exercise in pregnancy.

Treating an identified cause

Sometimes the cause of a miscarriage can be identified. In these cases, it may be possible to have treatment to prevent this causing any more miscarriages.

Antiphospholipid syndrome

Antiphospholipid syndrome (APS), also known as Hughes syndrome, is a condition that causes blood clots. It can be treated with medication.

Research has shown that a combination of aspirin and heparin (a medicine used to prevent blood clots) can improve pregnancy outcomes in women with the condition.

Read more about treating antiphospholipid syndrome.

Weakened cervix

A weakened cervix, also known as cervical insufficiency, can be treated with an operation to put a small stitch of strong thread around your cervix to keep it closed.

This is usually carried out after the first 12 weeks of your pregnancy.