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Miscarriage

Miscarriage is the spontaneous loss of a pregnancy before 20 weeks. Usually miscarriage happens because the fetus isn't developing as it should. Miscarriage is common. About 15% of pregnancies end in miscarriage, usually before the 12th week of pregnancy (during the first trimester).

Some miscarriages happen even before a woman knows she is pregnant. Miscarriage can be a traumatic, emotional experience. Most women who have miscarriages go on to have successful pregnancies later on. A second miscarriage occurs in only about 1% of women. However, some women may have multiple miscarriages.

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Signs and Symptoms

Signs and symptoms that often happen with a miscarriage include:

• Bleeding. Brown or bright red vaginal bleeding or spotting. Light bleeding early in pregnancy is fairly common, even in "normal" pregnancies, and does not mean you will have a miscarriage. Talk to your doctor.
• Passage of tissue from the vagina or a gush of clear or pink vaginal fluid.
• Abdominal pain or cramping.
• Signs of pregnancy may go away, such as breast sensitivity and morning sickness.
• Dizziness, lightheadedness, or feeling faint.

What Causes It?

Normal activities (like work, exercise, or sex) won't cause a miscarriage, nor will nausea and vomiting (even with severe morning sickness). Most often, a miscarriage happens because there is a problem with the baby's genes. But some health conditions can make the mother more prone to miscarriage, including:

• Physical problems with the uterus or cervix
• Poorly controlled diabetes
• Hyperthyroidism or hypothyroidism
• Hormonal problems
• Infection, including bacterial, viral, parasitic, fungal, or sexually transmitted diseases (STDs)

Who Is Most At Risk?

Women with the following conditions or characteristics are at greater risk for having a miscarriage:

• Two or more previous miscarriages
• Age 35 or older
• Smoking or drinking alcohol
• Using cocaine or other illegal drugs
• Environmental toxins -- excessive exposure to lead, mercury, organic solvents
• Having ongoing health problems, including thyroid disease
• Low levels of folic acid
• Taking certain antibiotics, including clarithromycin
• Having low levels of vitamin D

What to Expect at Your Provider's Office

If you think you are having a miscarriage, see your doctor immediately. Your doctor will do a pelvic examination to check for any problems with your uterus and see if it has begun to dilate. Your doctor will do an ultrasound to check on the baby's heartbeat and see how it is developing. If you have miscarried, your doctor may do a blood test to make sure there's no tissue is left inside your uterus.

Treatment Options

Prevention

In most cases, there is no way to prevent a miscarriage. You can avoid known risks, such as:

• Being overweight
• Caffeine or alcohol consumption
• Smoking cigarettes

Keep your body healthy by eating well, exercising regularly, and getting enough sleep. Your physician may also prescribe bed rest and progesterone if you have experienced previous miscarriages. Take thyroid and other medications as prescribed, and consider supplementing your diet with folic acid and vitamin D.

Treatment Plan

If you are threatening miscarriage, your doctor may tell you to rest and avoid sex and exercise. If your cervix is dilated and your uterus has started to contract, the miscarriage can't be stopped. In that case, your doctor may give you medication that causes your body to get rid of the placenta and tissue from the pregnancy. If any of the tissue remains inside your uterus, your doctor will perform a dilation and curettage (D&C), which involves dilating your cervix and gently suctioning out the tissue. If you have a history of unexplained miscarriages, in vitro fertilization, embryo transfer, or artificial insemination may be used to achieve a successful pregnancy.

Drug Therapies

If you have an underlying medical condition, or have had multiple miscarriages, your doctor may prescribe medication to encourage a successful pregnancy. This medication will depend on what your specific health problem is.

Surgical and Other Procedures

Dilation and curettage (D&C) can remove pregnancy tissue if it is not expelled naturally from the uterus. Other surgical procedures may help problems with the uterus.

Complementary and Alternative Therapies

Keeping your body healthy may lower your risk of a miscarriage. Before getting pregnant, it is a good idea to discuss the risks of miscarriage with a counselor, including the importance of staying healthy and avoiding caffeine, alcohol, and recreational drugs.

Miscarriage is a serious health issue. Ask your doctor about alternative therapies that may help you stay healthy during pregnancy. Never take any herb or supplement while you are pregnant without checking with your doctor first.

Nutrition and Supplements

These nutritional tips can help you stay healthy before and during pregnancy:

• Eat calcium-rich foods, including low-fat dairy, beans, almonds, and dark green, leafy vegetables, such as spinach and kale.
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat clean, healthy protein, preferably from organic, free-range sources.
• Use healthy cooking oils, such as olive oil.
• Reduce or eliminate trans-fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Drink 6 to 8 glasses of filtered water daily.
• Exercise regularly. But talk to your doctor about finding the right exercise program for you. If your pregnancy is high risk, your doctor may prescribe bed rest.
• Avoid caffeine, alcohol, and tobacco. These substances raise the risk of miscarriage.

Pregnant women may need these nutrients:

• Women who are pregnant need additional amounts folic acid (600 to 800 mcg per day). Often taken with a B-complex vitamin. Folic acid is needed for the normal development of the baby's neural tube, which becomes the brain and spine. Low levels of folic acid have been linked to miscarriage. Your doctor will prescribe prenatal vitamins that have the nutrients you need.
• Omega-3 fatty acids. Such as those found in cold-water fish, seem to reduce the chance of premature delivery. They are also necessary for the baby's brain health. Pregnant women should avoid fish containing high levels of mercury. The Food and Drug Administration says pregnant women may eat up to 12 ounces a week or two average-sized portions of shrimp, salmon, cod, catfish, canned light tuna (no more than 6 oz. (170 g) a week of albacore tuna and tuna steak), and pollock. If you don't eat fish, ask your doctor about taking supplements. Omega-3 supplements may increase the risk of bleeding, especially if you take blood-thinning medications, such as warfarin (Coumadin) or aspirin. Omega-3 supplements specifically designed for pregnant women are not available. Speak to your physician.
• A prenatal vitamin daily. Containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium, and iron. Ask your doctor.

Herbs

DO NOT use herbs during pregnancy unless you are under the care of a qualified health care provider. Work with your doctor to determine which herbs may be right for you.

Homeopathy

No studies show that homeopathy can prevent miscarriage. However, homeopathic literature does have reports of women who have had successful pregnancies after miscarriage when being treated with homeopathy. An experienced homeopath would consider your individual case and may recommend treatments to address your underlying condition and support your overall health.

Prognosis and Possible Complications

Many women who have one or two miscarriages go on to have successful pregnancies. Women have only a 1% chance of having another miscarriage after the first one. However, the risk goes up with each miscarriage. Possible complications include infected pregnancy tissue that could lead to pelvic abscess, septic shock, or even death.

Many women feel depression or guilt after a miscarriage. A support group or individual counseling may help to deal with these feelings.

Following Up

Your doctor will monitor you until the miscarriage is complete. If you have had a miscarriage and become pregnant, you should see your doctor right away.

Supporting Research

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Andersen JT, Petersen M, Jimenez-Solem E, et al. Clarithromycin in early pregnancy and the risk of miscarriage and malformation: a register based nationwide cohort study. PLoS One. 2013;8(1):e53327.

Andersen LB, Jorgensen JS. Jensen TK, et al. Vitamin D insufficiency is associated with increased risk of first-trimester miscarriage in the Odense Child Cohort. Am J Clin Nutr. 2015;102(3):633-638.

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Casikar I, Lu C, Reid S, Condous G. Does sympomatology at presentation correlate with successful expectant management of first trimester miscarriage: a prospective observational study. Aust N Z J Obstet Gynaecol. 2013;53(2):178-183.

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Review Date: 11/22/2016  

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M Editorial team.

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