Early pregnancy loss, also known as a miscarriage or spontaneous abortion, occurs in the first trimester of pregnancy. Miscarriage is a term used for a pregnancy that ends on its own, within the first 20 weeks of gestation. The loss of a pregnancy during the first 13 weeks of pregnancy (the first trimester) is called early pregnancy loss or miscarriage. Other terms include miscarriage, early pregnancy failure, and spontaneous abortion. Early pregnancy loss as a nonviable, intrauterine pregnancy with either an empty gestational sac or gestational sac containing an embryo or a fetus without a fetal heart activity within the first trimester.
Subtypes of early pregnancy loss include anembryonic gestation and embryonic or fetal death, inevitable abortion, and incomplete abortion.
The fact is, early pregnancy loss occurs in more than 10% of pregnancies; however, the women who face them don’t always realize they were pregnant at the time. Sometimes, an early pregnancy loss just looks like a period that came a little later than expected.
Most women go on to have successful pregnancies. Recurrent pregnancy losses or recurrent miscarriages are rare.
Causes of Early Pregnancy Loss
Each case of early pregnancy loss is different, and we may never know the exact cause. Research shows that about half of early miscarriages result from the chromosomal abnormalities in the embryo. We also know that your risk of early pregnancy loss increases as you get older.
Approximately 50% of all cases of early pregnancy loss are due to fetal chromosomal abnormalities. The most common risk factors identified among women who have experienced early pregnancy loss are advanced maternal age and a prior early pregnancy loss.
For your own peace of mind, it’s important to understand what actions do not cause early pregnancy loss.
You will NOT cause a miscarriage by:
Using birth control pills before pregnancy
Getting hit in the tummy
Being startled or “spooked”
Many researchers have looked into the question of whether substances like alcohol, caffeine, and tobacco can cause miscarriage. The results are mixed.
- Some studies suggest that smoking increases the risk, while others found no impact. Doctors highly recommend that you completely abstain from smoking during pregnancy.
- Drinking alcohol in the first trimester may slightly increase your chances of losing the pregnancy, but it’s hard to say for sure. To be absolutely certain that alcohol has no impact on your pregnancy, doctors highly recommend abstinence.
- Thankfully, caffeine does not seem to have an effect on your chances of miscarriage, as long as you have no more than 200mg per day. For reference, one cup of coffee contains about 100mg.
Symptoms of Early Pregnancy Loss
The most common symptoms of an early pregnancy loss are vaginal bleeding and cramping, but these are not sure signs. Symptoms of vaginal bleeding but not abdominal pain are associated with increased risk of miscarriage. Many women experience these in their first trimester, and their pregnancies continue normally.
Common symptoms of early pregnancy loss, such as vaginal bleeding and uterine cramping, also are common in normal gestation, ectopic pregnancy, and molar pregnancy. Before initiating treatment, it is important to distinguish early pregnancy loss from other early pregnancy complications. Treatment of an early pregnancy loss before a confirmed diagnosis can have detrimental consequences, including interruption of a normal pregnancy, pregnancy complications, or birth defects.
Diagnosis of Early Pregnancy Loss
If you are bleeding and cramping, please contact us. Bleeding and cramping may be signs of other serious complications, such as an ectopic pregnancy. We can perform a physical exam and an ultrasound to check on the development of the fetus. We may order blood tests to further evaluate the cause of these symptoms. It’s important that we check on you and take every precaution to ensure your health and safety.
If you have signs and symptoms of early pregnancy loss, you most likely will have a physical exam. Your obstetrician will ask you questions about when the bleeding started, how much you are bleeding, and whether you have pain or cramping. An ultrasound exam may be done to check whether the embryo is still growing in the uterus or to detect the presence of a heartbeat. You may have a test to measure the level of human chorionic gonadotropin (hCG) in your blood, a hormone produced during pregnancy; its detection is the basis for most pregnancy tests. This substance is made by the developing placenta. A low or decreasing level of hCG can mean loss of the pregnancy. Several ultrasound exams and hCG tests may be necessary to confirm that pregnancy loss has occurred.
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What Will Happen if the Pregnancy is Lost?
If you’ve miscarried, we need to make sure all the pregnancy tissues are removed from your uterus. There are both surgical and non-surgical options available. A woman with a spontaneous early pregnancy loss has an 80 to 90 percent chance of a normal pregnancy the next time she conceives.
Non-surgical post miscarriage care options
If there’s no risk of infection, it may be possible to allow the tissue to pass naturally, which usually takes 1-2 weeks. If necessary, your doctor can prescribe medication to help it pass more easily. The use of a single preoperative dose of doxycycline is recommended to prevent infection after surgical management of early pregnancy loss.
You should expect bleeding that is longer and heavier than your normal period. You may also pass tissue that resembles blood clots. Symptoms can include nausea, diarrhea, and/or painful cramps, for which we can prescribe you medication. Afterward, you should have an ultrasound to make sure all of the tissue has passed. Complete miscarriage means you have passed all of the pregnancy tissue. Your uterus or womb is empty and you don’t need any additional medical treatment
Consult with your women’s health care provider to avoid complications such an infection, and stick with follow-up checkups as needed. A miscarriage, whether early or not, can take a toll on a woman’s body.
Surgical post miscarriage care options
If your bleeding is heavy, or if you show signs of an infection, we will recommend surgical removal of the tissue. Many women prefer surgical evacuation to expectant or medical treatment because it provides more immediate completion of the process with less follow-up. There are two common procedures:
This procedure can be performed in our office. It involves inserting a thin tube into the uterus and using gentle suction to clear out the tissue. A local anesthetic can be used to make you more comfortable during the procedure.
Dilation and curettage (D&C)
A dilation and curettage (D&C) procedure can be performed in-office or at a surgery center. It involves dilating the cervix and using a special instrument to remove all of the tissue. You may receive general or regional anesthesia.
What Should I Expect When Recovering from an Early Pregnancy Loss?
To prevent infection, you should avoid vaginal intercourse for 1-2 weeks following the miscarriage. During this time, do not put any objects in your vagina, including tampons and birth control devices.
You should contact us right away if you show any signs of infection, such as:
- Severe Pain
- Heavy bleeding (going through two or more pads per hour, for longer than two hours)
Remember that early pregnancy losses are very common. The vast majority of women go on to have normal, healthy pregnancies after their first miscarriage. If early pregnancy loss becomes a pattern for you, please make an appointment for testing to determine the cause and a course of medical treatment and expectant management.
The early loss of a baby at any time in pregnancy can be emotionally and physically difficult for the mother and other members of the family. For some families, the timing of pregnancy loss may make the experience more or less difficult. For example, an early loss, before the mother even knew she was pregnant, may not be as stressful as a loss later in pregnancy, such as after feeling fetal movement or seeing the fetus on ultrasound examination. However, parents may have strong feelings and sadness whenever a loss occurs.
Talk to your doctor. He or she may be able to refer you to a local support group. There are also national resources you can access for support.