Miscarriage is medically defined as the spontaneous loss of a pregnancy before twenty weeks gestation. What you may not know about miscarriages is that they are far more common than most people think because many occur before a woman even realizes she is pregnant. Some studies indicate that 50 percent of all pregnancies end in miscarriage, some before implantation even occurs. Many early miscarriages are the result of genetic or chromosomal abnormalities.

Signs of a miscarriage include the following:

• Prolonged and heavy vaginal bleeding

• Cramping

• Sudden end of pregnancy symptoms such as breast tenderness, nausea, and fatigue

Types of Miscarriage

The medical term for a miscarriage is a spontaneous abortion. A miscarriage may occur and be complete, meaning that the pregnancy is completely lost and the cervix then closes. The medical term for this is a complete abortion. An incomplete miscarriage (medically termed an incomplete abortion) means a miscarriage has started but there is still tissue in the uterus, and the cervix is usually still open. If the cervix is open, but no tissue has been passed, a diagnosis of inevitable abortion is made, meaning that the pregnancy loss is inevitable. Because of the availability of early blood tests and ultrasounds, early miscarriages are frequently diagnosed prior to a woman experiencing any symptoms of miscarriage. Such pregnancies are termed missed abortions.

Sometimes, pregnancy loss after fourteen to sixteen weeks can be due to a special condition called incompetent cervix or cervical insufficiency. This occurs when the cervix dilates and thins painlessly, and the pregnancy literally “falls out” of the uterus.

It is important to understand that more than half of women have bleeding during the first twelve weeks of pregnancy without having a miscarriage. By following the levels and trends of pregnancy hormones and using ultrasound, a physician can usually determine with reasonable accuracy the likelihood of a miscarriage for a woman who is experiencing bleeding. However, you should always check with your doctor if you experience any bleeding during pregnancy. Bleeding from a miscarriage can last seven to ten days.

Miscarriage Treatment

If a miscarriage is suspected, your doctor will order a blood test to test your pregnancy hormones and do an ultrasound to determine if the pregnancy is continuing in the uterus. Early miscarriages (under six to eight weeks gestation) usually do not require treatment. Usually, the woman will complete the miscarriage at home without medical intervention.

Miscarriages occurring between nine to twelve weeks may require medical or surgical intervention. Surgical intervention is usually in the form of dilatation and curettage (D&C) or suction curettage, in which the lining of the uterus is scraped and a special catheter attached to a vacuum is used to empty the uterus. Another option is medical curettage, in which drugs are given to the woman that cause uterine contractions, emptying the uterus. The procedure is generally begun in the hospital and completed by the woman at home. The medications are either given orally or as vaginal suppositories.

The decision as to whether medical intervention is required and the type needed (medical or surgical) is determined based on the gestational age of the pregnancy, the heaviness of bleeding, and the emotional state of the woman. Missed abortions are particularly difficult for many women emotionally. Many women have difficulty waiting for the miscarriage to start or taking medications to induce the pregnancy loss and opt for suction curettage. Medical curettage also has a small failure rate and surgical curettage may be required at a later point.

Curettage may also be recommended if your doctor wishes to send the miscarriage tissue for certain types of testing, such as chromosome analysis, to determine the possible cause of the miscarriage. Suction curettage may be performed in an examination room or in an operating room under anesthesia, depending on the circumstances. Miscarriages occurring after twelve to fourteen weeks gestation usually require formal medical evaluation and have a much higher chance for heavy bleeding and for requiring some form of medical intervention.

Once a miscarriage has been diagnosed by pregnancy hormones or ultrasound, or has already begun to happen, there is nothing that can be done to stop it. The one exception is an incompetent cervix. If this is diagnosed early enough, there is possibility of a cervical cerclage (a stitch placed around the cervix), which can prevent a miscarriage. For most miscarriages, you do not need to go to the hospital unless your doctor directs you to or if you cannot reach your doctor. Advil or Motrin, as well as a heating pad, is recommended for cramps.

If you pass tissue at home, it is important that you collect the tissue the best that you can and place it in some type of clean container or jar, preferably with a lid. This is important to confirm that you actually had a miscarriage and will help your doctor to determine if the miscarriage is complete. Sometimes in an ectopic or tubal pregnancy the woman may bleed and pass only the uterine lining. Without a tissue specimen, it can be very difficult to determine if the woman had a miscarriage or has a tubal pregnancy in progress.

Your doctor may follow up after the miscarriage with testing to try to determine if there was a cause. The amount and types of tests vary with the gestational age of the miscarriage, your age, or how many previous miscarriages you have had. Because you are over 35 years old, you should request that your doctor send the miscarriage tissue for chromosome testing. If a chromosome abnormality is found, other underlying causes of miscarriage are excluded, saving you from additional testing. If you have repeat miscarriages, you may be referred to a specialist. If the fetus was recovered during the miscarriage (usually only in a late miscarriage), your doctor may wish to do testing on the remains. Your physician will most likely recommend that you wait one cycle before trying to conceive again.

The most important thing to understand about miscarriage is that it is not the woman's fault. There is nothing a woman can do to prevent or stop a miscarriage from happening. Most are nature's way of handling an abnormality. This, however, does not mean that the miscarriage is not a loss and is not important. You should grieve for your lost baby and give yourself time to cope with it. It also does not mean that you are somehow defective as a woman and that you won't be able to have a successful pregnancy in the future.

Well-meaning friends and family often say things that aren't exactly helpful, such as “It's nature's way of correcting a mistake” or “It's better than having a child with a deformity” or “You'll have another one.” These people think they are helping, but they may not be. Take the time you need to mourn the loss you have suffered, and don't let what people say get to you.