Miscarriage: Symptoms, Causes, Treatments, and Prevention

Miscarriage is the unexpected loss of a pregnancy before the 20th week, and, unfortunately, it is more common than many realise. While it can be an emotionally difficult experience, most miscarriages occur due to natural factors, such as genetic or developmental issues, rather than anything a person did or didn’t do.

Learning about the symptoms, causes, diagnosis, and treatment can help bring clarity during an uncertain time. This guide offers compassionate, evidence-based information to support understanding, healing, and planning for the future.

What Is a Miscarriage?

A miscarriage is the loss of a pregnancy before 20 weeks. The word itself can sometimes feel misleading, as if it suggests blame. In reality, most miscarriages happen because the baby does not develop properly, not because of anything the mother did or did not do.

In India, about 5 out of every 100 pregnancies (4.9%) are reported to end in miscarriage, and nearly a quarter of these occur in the first 12 weeks (23%). The actual number is likely higher since many very early losses happen before a woman even realises she is pregnant.

Types of Miscarriage

Missed Miscarriage

In this type, the pregnancy has ended, but there are no noticeable symptoms such as bleeding or cramping. It is usually discovered during an ultrasound when no heartbeat is detected and the fetus has stopped developing.

Complete Miscarriage

A complete miscarriage occurs when all pregnancy tissue has passed from the uterus. This is often accompanied by bleeding and cramping, and an ultrasound can confirm that the uterus is empty.

Recurrent Miscarriage

This refers to having three or more pregnancy losses in a row, usually in the first trimester and with the same biological partner. It is rare, affecting about 1% to 2% of couples, and in roughly half of these cases, doctors are unable to find a specific cause.

Threatened Miscarriage

In this situation, vaginal bleeding and abdominal cramps may occur, but the cervix remains closed. Many pregnancies continue without further problems, though extra monitoring and rest may be advised.

Inevitable Miscarriage

This type involves bleeding and cramping along with dilation of the cervix. Amniotic fluid may also leak, and in most cases, pregnancy loss cannot be prevented at this stage.

READ: 10 Tips to Prepare for a Healthy Pregnancy After Miscarriage

Miscarriage Symptoms

The common symptoms of miscarriage include:

• Vaginal bleeding that may become heavy, sometimes with clots or tissue
• Abdominal cramps or pain, often stronger than menstrual cramps
• Lower back pain, ranging from mild to severe
• A sudden loss of pregnancy symptoms, such as breast tenderness or nausea
• Passing fluid or tissue from the vagina
• Loss of fetal movement or heartbeat (in later weeks of early pregnancy)

If you experience any of these signs of early miscarriage, contact your doctor right away. They will advise whether you need an examination, an ultrasound, or urgent care.

Causes of Miscarriage

Miscarriage can happen for many reasons, and often more than one factor may play a role. While it is not always possible to pinpoint the exact cause, research has identified several common contributors. Some common reasons for miscarriage are:

Genetic or chromosomal issues:

Over 50% of first-trimester miscarriages (up to 13 weeks) are linked to abnormal chromosomes in the embryo.

Hormonal imbalances:

Problems such as low progesterone or thyroid disorders can interfere with a healthy pregnancy.

Maternal health conditions:

Uncontrolled diabetes, severe kidney disease, congenital heart disease, lupus, and other immune system disorders may increase the risk.

Uterine or cervical problems:

Structural abnormalities, an incompetent cervix (cervix opening too early), or poor implantation of the fertilised egg can lead to pregnancy loss.

Infections:

Certain infections, including TORCH infections (toxoplasmosis, rubella, cytomegalovirus, herpes, and others), can contribute to miscarriage.

Lifestyle factors:

Smoking, drinking alcohol, recreational drug use, and severe malnutrition all raise the risk.

Age:

As maternal age rises, the risk of miscarriage also increases: about 15% for women under 35, 20-35% for those between 35 and 45, and up to 50% for women over 45. Most of these age-related miscarriages occur due to chromosomal abnormalities, where the fetus has too many or too few chromosomes.

Previous Miscarriage:

A history of one or more miscarriages raises the risk of another to about 25%, only slightly higher than for someone with no previous miscarriage.

Medications and environmental exposures:

Some prescription drugs, such as isotretinoin for acne, as well as radiation exposure, may be harmful to pregnancy.

Obesity:

Being significantly overweight can increase the likelihood of miscarriage.

READ: Post pregnancy diet: 5 foods for new moms

Factors That Do Not Cause Miscarriage

Many everyday activities do not increase the risk of miscarriage:

• Exercise (generally safe when healthy, but avoid injury-prone activities)
• Sexual activity
• Stress from arguments
• Using birth control before pregnancy
• Working (unless exposed to high levels of harmful chemicals or radiation)
• Mild illness, such as a cold or the flu
• Normal travel or commuting
• Flying on commercial aeroplanes
• Moderate caffeine intake
• Household chores
• Lifting light objects

It’s common to feel guilty after a miscarriage, but in most cases, it happens due to random factors beyond anyone’s control.

Miscarriage Diagnosis

To diagnose a miscarriage, doctors may use several tests and examinations. The first step is usually an ultrasound, which checks whether the fetus has a heartbeat and if early structures, such as the yolk sac, are visible.

A blood test may also be done to measure levels of human chorionic gonadotropin (hCG), the hormone produced during pregnancy. Falling or unusually low hCG levels can indicate that the pregnancy is not developing normally.

In some cases, a pelvic examination is performed to determine if the cervix has started to dilate, which may be a sign that a miscarriage is in progress.

Miscarriage Treatment

Treatment depends on whether the uterus has cleared the pregnancy tissue on its own.

Complete Miscarriage:

If the uterus clears all tissue on its own, usually no further treatment is required. An ultrasound is often done to confirm this.

Medication:

If some tissue remains or miscarriage bleeding hasn’t started, your doctor may prescribe medicines to help the uterus expel the pregnancy. This option is most effective in early pregnancy miscarriages.

Surgery:

If bleeding is severe, tissue remains despite medication, or the miscarriage occurs later in pregnancy, surgical procedures such as dilation and curettage (D&C) or dilation and evacuation (D&E) may be recommended. These safely remove remaining tissue and reduce the risk of infection or heavy bleeding.

Common After-Miscarriage Symptoms

Physical recovery after a miscarriage often takes only a few hours to a few days. Light bleeding (spotting) and mild cramps are the most common symptoms during this period.

Sometimes, tissue left behind in the uterus can cause an infection, called a septic miscarriage, which may develop within a couple of days. Signs of infection can include:

• Fever above 100.4°F on more than one occasion
• Chills or shivering
• Pain or tenderness in the lower abdomen
• Foul-smelling or unusual vaginal discharge
• Ongoing or heavy bleeding

If you experience any of these symptoms, seek medical help immediately.

To lower the risk of infection, avoid putting anything into the vagina, including tampons or having sexual intercourse, for at least two weeks after a miscarriage. Your doctor will also schedule a follow-up visit to monitor your recovery and address any possible concerns.

Preventing Miscarriage

Most miscarriages can’t be avoided, but you can lower some risks by looking after your health and giving your pregnancy the best possible care.

• Keep up with all scheduled prenatal checkups
• Maintain a healthy body weight
• Stay away from alcohol, smoking, and other miscarriage risk factors
• Take prenatal vitamins as recommended
• Follow a balanced diet and stay physically active

Life After a Miscarriage

Having a miscarriage can be emotionally and physically challenging, but many people go on to have healthy pregnancies. It’s possible to get pregnant as soon as your first period after a miscarriage, though it’s important to give yourself time to heal and feel ready. Most miscarriages happen only once, with two in a row being rare and three even less common (about 1%).

If you’ve experienced more than one miscarriage, your doctor may suggest tests to look for possible underlying causes. Even when no specific reason is found, there is still hope. Many people who’ve had multiple miscarriages go on to have a full-term pregnancy. Alongside medical care, leaning on support from loved ones, friends, or support groups can help you recover emotionally and feel ready for the next chapter.