Miscarriage

Diagnosis

To evaluate a suspected miscarriage, your health care team may recommend several tests to understand what is happening and to confirm the diagnosis.

Blood tests are commonly done to measure the level of the pregnancy hormone human chorionic gonadotropin, also known as hCG. This test is often repeated after about 48 hours to observe how the levels change. Low, falling or irregular hCG levels may suggest pregnancy loss and may lead to further blood testing or an ultrasound. Your blood type may also be checked. If you are Rh negative, treatment with Rh immunoglobulin may be recommended, unless you are less than six weeks pregnant.

A pelvic exam may be performed to see whether the cervix has started to open. An open cervix can increase the likelihood of a miscarriage.

An ultrasound allows the health care professional to look for a fetal heartbeat and assess whether the pregnancy is developing normally. If the findings are unclear, another ultrasound may be required after about a week.

If tissue has passed from the vagina, it may be sent to a laboratory to confirm that a miscarriage has occurred and to rule out other causes of symptoms.

If you have had two or more previous miscarriages, chromosomal testing may be advised for you and your partner. These blood tests can help identify whether chromosome-related issues may increase miscarriage risk.

Based on test results, your health care professional may use one of the following terms to describe the situation:

• Threatened miscarriage, where vaginal bleeding occurs but the cervix is closed and the pregnancy may continue normally

• Inevitable miscarriage, which involves bleeding, cramping and an open cervix, making the pregnancy loss unavoidable

• Incomplete miscarriage, meaning some pregnancy tissue has passed but some remains in the uterus

• Missed miscarriage, where pregnancy tissue stays in the uterus but the embryo has died or never formed

• Complete miscarriage, in which all pregnancy tissue has passed, usually before 12 weeks

• Septic miscarriage, a serious uterine infection following miscarriage that requires urgent medical treatment

Treatment

The recommended treatment depends on whether the pregnancy is continuing, at risk or has ended, as well as on your symptoms and overall health.

For a threatened miscarriage, vaginal bleeding early in pregnancy may lead your health care team to recommend rest until symptoms improve. Bed rest and similar measures have not been proven to prevent miscarriage, but they are sometimes advised as a precaution. Tampons and sexual intercourse should be avoided while bleeding continues to reduce the risk of uterine infection. In certain cases, delaying travel may be suggested, especially if access to medical care would be limited.

If tests confirm a miscarriage or show that one is likely, treatment options may include expectant management, medical treatment or surgical treatment.

• Expectant management allows the miscarriage to progress naturally without intervention if there are no signs of infection. This approach is commonly used during the first trimester and may take days to several weeks. If pregnancy tissue is not passed completely, medication or surgery may be needed.

• Medical treatment uses medicines to help the uterus expel pregnancy tissue. A combination of mifepristone and misoprostol is more effective than misoprostol alone and is associated with a lower chance of needing surgical treatment.

• Surgical treatment involves a minor procedure known as suction dilation and curettage, or uterine aspiration. The cervix is opened and remaining tissue is removed from the uterus. Complications are uncommon, but the procedure is recommended if there is heavy bleeding or signs of infection.

After a miscarriage, people who are Rh negative may receive an injection of Rh immunoglobulin to help prevent complications in future pregnancies. Those who are Rh positive do not need this treatment.

Physical recovery

Physical recovery after a miscarriage usually takes a few hours to a couple of days. Contact your health care professional if you experience symptoms such as heavy bleeding that soaks more than two pads an hour for over two hours, fever, chills or abdominal pain.

Most people get their next menstrual period about two weeks after bleeding or spotting ends. Birth control can be started right away, but it is advised to avoid sexual intercourse or placing anything in the vagina, including tampons, for one to two weeks to reduce infection risk.

Future pregnancies

Pregnancy can occur during the menstrual cycle following a miscarriage. Before trying again, it is important for both physical and emotional recovery. Your health care professional can provide guidance on when to attempt conception.

In many cases, miscarriage occurs only once. Most people who experience a miscarriage go on to have a healthy pregnancy in the future. A small percentage have two or more miscarriages in a row. If multiple pregnancy losses occur, testing for underlying causes such as uterine abnormalities, chromosomal conditions, blood clotting disorders or immune system issues may be recommended.

Even when no cause is found, the chances of having a full-term pregnancy remain good. Many people with recurrent miscarriages eventually achieve a healthy pregnancy with proper care and support.