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Miscarriages are very common in early pregnancy. More than 10% of pregnancies end in miscarriage, according to the American College of Obstetrics and Gynecology. Of course, that doesn’t make miscarriage any less distressing.

A miscarriage is a pregnancy loss that occurs in the first 20 weeks of pregnancy. (After that, doctors call pregnancy loss a stillbirth).

If you think you might have signs of miscarriage, see a health provider. They will help you through the emotional and physical process.

What Are the Signs of Miscarriage?

In some cases, women don’t have any signs of a miscarriage. They may find out they miscarried during a routine ultrasound. Signs and symptoms of miscarriage include:

• Bleeding or spotting from the vagina.
• Cramps that are usually worse than period cramps.
• Decreased movement of the fetus (for second-trimester losses).
• Passing fetal tissue, which may look greyish-white or like a fluid-filled sac.
• Sudden loss of pregnancy symptoms, like nausea and breast tenderness.

Having symptoms of miscarriage doesn’t mean you are having a miscarriage, however. Pregnancy symptoms go up and down. Many women find their nausea goes away as they get closer to their second trimester.

Bleeding also doesn’t always mean a miscarriage is happening, according to the American College of Obstetricians and Gynecologists. About half of women who experience bleeding in early pregnancy will have a normal pregnancy and birth.

What Should I Do if I Have Symptoms of Miscarriage?

Reach out to whoever is caring for you during pregnancy. That may be your obstetrician, midwife, or family doctor. Many pregnancy providers have a 24-hour call line.

If you have heavy bleeding (soaking two large pads over one hour) that lasts 2 hours or longer, go to the emergency department. Also, go to the emergency department if you have concerning symptoms in addition to miscarriage symptoms. These include feeling lightheaded or having a fever.

Your pregnancy provider will ask about your symptoms, including when they started and how severe they are. In most cases, they’ll ask you to come in for an examination. Your provider may look at your cervix to see if it’s dilated, a sign of miscarriage.

They can also order blood tests to check for the “pregnancy hormone,” called hCG. They will repeat this test after two or three days to confirm a miscarriage. If this level drops or rises too slowly, that suggests a miscarriage.

Another test to check for miscarriage is an ultrasound to show if the fetal heart has stopped. An ultrasound uses harmless sound waves to create moving images of the uterus and fetus.

People who have signs of miscarriage may want to ignore them to avoid feelings of fear and grief. But it’s important not to delay health care for a miscarriage. In rare cases, miscarriages can cause serious health problems if left untreated.

Bleeding and cramping can also be the sign of an ectopic pregnancy. An ectopic pregnancy can be life-threatening and requires medical care.

How Do Health Providers Treat Miscarriage?

Your health provider can offer treatment options once they confirm a miscarriage. These can include waiting for the miscarriage to happen naturally. Providers may also offer medication to speed up the process or recommend surgery.

Non-medicated miscarriage

A natural miscarriage can take days or more than a week for all the tissue to pass through the vagina. You can take over-the-counter pain relievers. But you should see your doctor if the pain medication isn’t working or you have signs of complications listed below.

Book a follow-up appointment to make sure that you are healing well physically and emotionally.

Medicated miscarriage

Medication helps the tissue pass from the uterus and helps to reduce bleeding after a miscarriage. It usually ensures the miscarriage is over within 48 hours, so you can stay home while the miscarriage happens.

While medication gives you more control over timing, it can increase cramping. Your doctor can offer over-the-counter or prescription painkillers to help.

You may also experience tummy upset from the medication. Your doctor can tell you more about the pros and cons of medication to speed up a miscarriage. If you choose medication, your doctor will follow up with you to make sure it works.

Surgery

If you have heavy bleeding or certain health conditions, like a bleeding disorder, surgery may be the best option. You may also need surgery if you have a miscarriage but some or all of the tissue remains in the uterus.

The surgery for miscarriage is a dilation and curettage (D&C). During a D&C, the doctor passes a surgical instrument through the cervix and removes the tissue from the uterus. The doctor may use a suction device instead, or in addition, to remove material from the uterus.

You will have medication to numb the area, or you may have anesthesia so you are asleep. This will depend on how far along your pregnancy was and other factors.

Your health provider will book a follow-up visit to make sure that you are healing well physically and emotionally.

Complications of Miscarriage

In rare cases, miscarriage can cause health problems, like infection or too much bleeding. Seek emergency care if you have any signs of miscarriage complications, including:

• Chills.
• Fever (temperature above 100.4°F).
• Heavy bleeding (soaking through two large pads in one hour) for two or more hours.
• Severe pain (pain that doesn’t go away despite over-the-counter pain relievers).

Why Miscarriages Happen

You may blame yourself, but a miscarriage isn’t your fault. There wasn’t anything you could do differently in your pregnancy to avoid it.

In most cases, miscarriages occur because of abnormal chromosomes in the embryo. About 80% of miscarriages occur in the first trimester, with some happening before women know they’re pregnant.

Most people who have a miscarriage go on to have a healthy baby if they choose to get pregnant again. Talk to your doctor if you have more than one miscarriage.

Coping with Miscarriage

You may feel a range of emotions during and after a miscarriage. Depending on whether you wanted to be pregnant or not, you may feel grief, anger, relief, and anxiety. Your emotions may change from day to day. Hormone changes before and after miscarriage can affect your mood as well.

Take the time to talk to those who care about you. Your health provider can also help you process your feelings and recommend a therapist or support group in your area. You can also find pregnancy loss resources in your area at SHARE: Pregnancy and Infant Loss Support.