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How Do I Know If I've Had a Miscarriage?

Vaginal bleeding during pregnancy may be the first warning sign of a miscarriage. However, about 20% of women have vaginal bleeding during the first 12 weeks of pregnancy, and less than half of them miscarry. To determine whether you have had a miscarriage, you should retain any clot-like material passed from your vagina during pregnancy so that your doctor can determine its source and whether any pregnancy-related material remains in your uterus.

If you are pregnant and bleeding vaginally, your doctor will probably use an ultrasound to help assess whether your pregnancy is healthy. An ultrasound can help determine whether there is a fetal heartbeat and whether the amniotic sac (which surrounds a fetus) is normal. It can also help determine whether the pregnancy is ectopic (occurring outside the uterus, such as in one of the fallopian tubes) and whether you may have spontaneously aborted one fetus in a multiple pregnancy.

A blood test can determine whether pregnancy hormones are developing as they should. A complete blood count (CBC) may be done to determine the degree of blood loss, and several other tests may be done to rule out potential infection. Your doctor may also perform a pelvic exam, looking for signs of miscarriage, including changes to the cervix and ruptured membranes. Your blood type will also be checked. If you are Rh negative and have miscarried, a shot will be recommended to help prevent problems in future pregnancies.

Usually after only one miscarriage, doctors don't recommend special testing to look for a cause. The chances are excellent that the next pregnancy will be healthy. If you have two or more miscarriages, you should consider consulting an ob-gyn who specializes in or has extensive experience with miscarriage. You and your partner should consider undergoing genetic testing.

An X-ray or ultrasound of your reproductive organs may be recommended to look for structural differences that may have played a role in your miscarriages. Special hormone tests and tests for connective tissue disorders in the mother may be helpful. Even among women who have had three or four miscarriages, 75% will go on to have a successful pregnancy.

What Are the Treatments?

More often than not little can be done to stop a miscarriage. Many doctors recommend bed rest but there is little scientific evidence that being on bed rest will change the outcome. Treatment of an actual miscarriage depends on your symptoms. The primary goal of treatment during and after a miscarriage is to prevent hemorrhaging and infection.

If your doctor determines that you face a threatened abortion, he or she may recommend that you stay in bed, restrict activity and abstain from intercourse until the signs are gone. However, it's not clear whether these measures help.

If vaginal bleeding fills more than one sanitary pad in half an hour, you should contact your doctor again. Heavier bleeding and cramping often indicate that a threatened abortion is progressing. In most cases, a woman's body expels all of the pregnancy tissue. The earlier the pregnancy, the more likely that your body will complete the miscarriage on its own.

After a miscarriage - if all pregnancy tissue wasn't expelled - treatment may be necessary to stop bleeding and prevent infection. A dilation and curettage (D&C) involves the widening of the cervix and scraping of the uterine lining, or endometrium; it is the most common procedure. Sometimes suction is used along with scraping. This procedure can be uncomfortable, so pain medications or anesthetic medications are often used.

You may be given antibiotics or other drugs afterward to minimize bleeding. Additional vaginal bleeding should be monitored closely. You should also find out whether you are Rh negative. If you are, you probably will need a shot of Rh0 immune globulin vaccine to prevent problems in future pregnancies.

IMPORTANT! Septic (infected) abortions are rare in cases of miscarriage, but if you have a fever or chills, this may indicate infection and you should see your doctor. The pregnancy tissues must be removed and you should receive antibiotics to prevent further serious illness.

Incompetent cervix

In an incompetent cervix the miscarriage occurs because there is a weakness of the cervix which cannot hold the pregnancy. A miscarriage from an incompetent cervix usually occurs after the 14th-16th week of the pregnancy.

There are usually little symptoms prior to a miscarriage. The woman feels sudden pressure, the water bag may break and the fetus and placenta may be expelled without too much pain. An incompetent cervix can usually be treated with a stitch in the cervix in the next pregnancy, usually around 12 weeks.

Recovering Emotionally

It is common and normal to feel sad after losing a wanted pregnancy. Many couples feel the grief of losing a child. This is normal - allow yourself time to grieve. Consider joining a support group where you can talk about your experience and feelings with others who have had a miscarriage. Family and friends may want to be comforting but may feel like they don't know how best to respond. If you can, let them know that you need their support, tell them what they can do and rely on their help.

Miscarriage can be a physical and emotional challenge for you and your partner. The stress in a relationship can be high. Some people may be tempted to blame themselves or their partner for the miscarriage - even though it's highly unlikely that either of them did anything to cause it or could have done anything to prevent it.

Keep in mind that there is a good chance that you will give birth to a healthy baby in the future. For example, only about 20% of women who have had a miscarriage have another the next time they become pregnant. About 35% of women who have had two consecutive miscarriages have a third. It's important to work with your doctor to determine the reason for your miscarriage, if possible, and to plan a future pregnancy.

Though it's possible to become pregnant right after a miscarriage, most experts recommend waiting until after you have one or two normal menstrual cycles.