What Is Pregnancy Loss?
Pregnancy loss is the umbrella term for the death of a fetus at any time during pregnancy. Most pregnancy losses happen in the first three months after conception, but they can occur later as well.
Types of pregnancy loss
The language surrounding pregnancy loss can be confusing. The following are some common terms and definitions.
Miscarriage
Doctors define miscarriage as a pregnancy loss before the 20th week of gestation. They estimate that 10% to 20% of all known pregnancies end in miscarriage. Most happen in the first eight weeks of pregnancy.
Miscarriage is also called spontaneous abortion, but it's not the same as medication abortions or abortion procedures. Miscarriage is a natural occurrence.
Doctors use the following terms to classify miscarriage:
- Complete miscarriage — When the embryo and all of the pregnancy tissue empty out of the uterus. You have cramping and bleeding, but those symptoms usually go away in a few days to a week.
- Incomplete miscarriage — When some but not all fetal tissue gets expelled from the cervix. An incomplete miscarriage causes continued pain and bleeding.
- Inevitable miscarriage — When the miscarriage hasn’t happened yet, but doctors can’t stop symptoms.
- Infected miscarriage — When the lining of the uterus and remaining fetal tissue develop an infection.
- Missed miscarriage — When the fetus dies but stays in the uterus. Pregnancy symptoms may stop, and an ultrasound shows no heartbeat.
- Recurrent miscarriage — When you’ve had three or more miscarriages in your first trimester.
- Threatened miscarriage — When you have bleeding and cramping but the cervix is still closed. You may or may not have a miscarriage.
Stillbirth
A stillbirth is a pregnancy loss after the 20th week of gestation. It can happen before, during, or right after delivery.
Stillbirth is much less common than miscarriage. About one baby in 100 is stillborn. Each year, about 24,000 babies are stillborn in the U.S. The cause of stillbirth is often unknown.
Other types of early pregnancy loss
There are other problems result in an early pregnancy loss.
- Chemical pregnancy — A very early miscarriage, usually in the first few weeks after conception, when the embryo doesn’t develop normally because of chromosomal problems. The tissue passes around the same time you’d have your period, so you may not even know you were pregnant.
- Embryonic pregnancy (blighted ovum) — When the fertilized egg implants in the uterine wall but never develops.
- Ectopic pregnancy – When the embryo develops outside the uterus and can't survive. An ectopic pregnancy may happen in a fallopian tube, the cervix, the pelvis, or abdomen.
- Molar pregnancy — A rare occurrence where abnormal tissue grows instead of an embryo. A molar pregnancy isn't able to survive because it’s not a true pregnancy, but can still cause symptoms like missed periods, nausea, and a positive pregnancy test.
What Causes Pregnancy Loss?
Most pregnancy losses happen because of chromosome problems that make it impossible for a baby to develop. Chromosomes are the genetic “building blocks” that guide the baby’s development. If the fertilized egg or fetus has an abnormal number of chromosomes, it can’t continue to grow.
Other possible causes of pregnancy loss include:
- A serious infection or injury.
- Blood clotting disorders.
- Chronic disease, such as uncontrolled diabetes.
- Drug or alcohol use.
- Exposure to toxic substances in the environment.
- Genetic issues with either parent.
- Health problems, such as polycystic ovary syndrome (PCOS).
- Hormone problems.
- Immune response problems.
- Obesity.
- Problems with the uterus or cervix, such as fibroid tumors.
- Smoking.
In most cases, doctors don’t know what causes pregnancy loss. As emotionally difficult as pregnancy loss is, you shouldn’t feel guilty or responsible for it.
What doesn't cause pregnancy loss
Pregnancy loss rarely happens because of something you can control.
These factors don’t cause pregnancy loss:
- Exercising.
- Feeling stressed.
- Having used birth control pills before getting pregnant.
- Having a fright.
- Having sex.
- Minor injuries, like falling.
- Morning sickness.
- Taking most medicines.
- Working.
Risk Factors for Pregnancy Loss
Certain factors put you at greater risk for having a miscarriage or stillborn baby.
Your age
The older you are when you get pregnant, the more likely you are to have a pregnancy loss. The risk of miscarriage is 10% among women 25 to 29, rising to 53% among women 45 and older.
Previous miscarriage
After one miscarriage, the risk of having another increases by half. After two miscarriages, the risk doubles, and after three consecutive miscarriages, the risk is four times greater.
Certain medical conditions
You're at great risk for pregnancy loss if you have a medical condition like diabetes, thyroid disease, PCOS, or immune system problems. However, many people with these conditions have healthy pregnancies. You should talk to your doctor about how your specific condition affects pregnancy.
Symptoms of Pregnancy Loss
The most common symptom that you may experience with a pregnancy loss is cramping and bleeding. However, some spotting and bleeding can happen during pregnancy, especially in the first few months. Bleeding doesn’t always mean you’re having a miscarriage.
However, you should call your doctor right away if you have any bleeding during pregnancy.
Also call your doctor immediately if you have any of the following signs of pregnancy loss:
- A blood clot passing from the vagina.
- A gush of fluid from your vagina, even if you don’t have pain or bleeding.
- Back pain that’s mild to severe.
- Cramping that’s worse than menstrual cramps.
- Painful contractions that happen every five to 20 minutes.
- Sudden weight loss.
- Vaginal discharge that’s pink in color.
If you’re more than 20 weeks along in the pregnancy, signs of pregnancy loss may be different. The most common sign of a problem at this stage of pregnancy is when you feel the baby's movements slow down or stop.
Complications from pregnancy loss
It’s rare to have complications from a miscarriage, but they can happen. The most common complication is an infection if tissue from the fetus or placenta remains in your uterus.
Symptoms of an infection include:
- Cramping.
- Fever.
- Foul-smelling vaginal discharge.
- Vaginal bleeding that doesn’t stop.
You should always seek medical attention when you think you’re having a miscarriage or may have had a miscarriage.
Diagnosing Pregnancy Loss
Once you get to the doctor, they'll ask you questions about your symptoms, including when they started and ended. If you’re still having symptoms, they’ll want to know how long they’ve been happening.
Your doctor may perform an ultrasound to take a look at what’s happening in your uterus. An ultrasound can show if the fetus is still growing, and if there's a heartbeat.
Your doctor may also do a pelvic exam to see if your cervix has begun to dilate, or open. A dilated cervix means that a miscarriage is more likely.
Your doctor may also order blood tests to reveal your pregnancy hormone levels. Human chorionic gonadotropin (hCG) is the substance detected in pregnancy tests. A drop in hCG may show that you’re losing the pregnancy.
Treatment for Pregnancy Loss
If you experience signs of a pregnancy loss, you should seek medical help right away.
Miscarriage treatment
Even if you think you’ve passed all of the pregnancy tissue, you should still see a doctor.
The two types of treatment for a miscarriage are surgical and non-surgical.
Non-surgical pregnancy loss treatment
Your doctor may advise you to let the pregnancy tissue pass naturally, without any extra treatment. That might take a few days or up to a couple weeks. Or, they may give you medicine to help the tissue pass more quickly.
When you pass the tissue, you may have:
- Cramping.
- Diarrhea.
- Heavy bleeding.
- Nausea.
- Pain.
If it’s early in the pregnancy, the amount of tissue will be small. It will look more like a blood clot with gray material than a baby. It may also look like a clear, fluid-filled sac.
Your doctor may ask you to keep some of the tissue that passed so they can examine it. They may be able to test it for chromosomal abnormalities.
Your doctor can give you pain medication to ease your symptoms. Once you’ve stopped passing fetal tissue, they'll do an ultrasound and/or blood tests to make sure no tissue remains in the uterus.
Surgical pregnancy loss treatment
If there are any complications with your miscarriage, your doctor may recommend surgical treatment.
Those complications could be:
- Heavy bleeding.
- Infection.
- Pregnancy tissue that remains inside your uterus instead of passing.
Surgical miscarriage treatments include:
- Dilation and curettage (D&C) — Doctors gently open the cervix and use an instrument to remove pregnancy tissue. A D&C can happen in the doctor’s office or a hospital, and you may be under local or general anesthesia.
- Vacuum aspiration — Doctors insert a thin tube into your uterus and connect it to a suction device. The tube sucks any remaining pregnancy tissue out of your uterus. This procedure usually happens in the doctor’s office with local anesthesia.
After surgical treatment, you shouldn’t put anything in your vagina for a few weeks. That includes having sex or using tampons. Your doctor will give you specific instructions on when you can resume normal activities.
You'll probably resume your normal menstrual cycle within four to six weeks. You should wait at least one regular menstrual cycle before trying to become pregnant again.
Your doctor will want to see you for a follow-up visit a few weeks after your miscarriage. But you should call your doctor right away if you experience signs of infection.
Infection signs include:
- Chills.
- Fever.
- Heavy bleeding (soaking through more than two maxi pads per hour for more than two hours).
- Severe pain.
Treatment for stillbirth
If you’re well past 20 weeks of pregnancy and your baby dies in the uterus, your doctor may recommend inducing labor and delivery. If the pregnancy is closer to 20 weeks, they may recommend a D&C.
If possible, they'll examine the baby and placenta to help find the cause of death.
Can You Prevent Pregnancy Loss?
You can’t prevent most pregnancy losses. Getting prenatal care early in pregnancy is the best way to minimize your risk of pregnancy loss. But there are other things you can do to reduce your risk factors.
You should:
- Avoid toxic substances in the workplace and at home.
- Avoid having x-rays.
- Cut back on caffeine.
- Cut out alcohol while you’re pregnant. No amount of alcohol is safe for a developing fetus. If you have an alcohol use disorder, now is the time to reach out for help.
- Manage any chronic diseases, like diabetes.
- Stop taking recreational drugs. If you use drugs, get help so you can quit.
- Quit smoking.
- Take a prenatal vitamin to get folic acid, which can lower the risk of spinal cord birth defects. Getting enough folic acid may also help lower the risk of miscarriage.
Trying to Get Pregnant Again
Pregnancy loss is physically and emotionally traumatic. You should take time to grieve your loss and recover before trying to get pregnant again.
Talk to your ob-gyn about the best time to try conceiving again. At the very least, you should wait at least one full menstrual cycle before trying to get pregnant again.
For most women, pregnancy loss is a one-time event. You may feel apprehensive about trying again, but know that most women who have a pregnancy loss go on to have healthy pregnancies.
Dealing With Pregnancy Loss
Pregnancy loss — whether by miscarriage or stillbirth — can be extremely upsetting. You looked forward to welcoming a new member of the family, and instead you're grieving a loss. Emotional healing may take longer than physical healing.
After a pregnancy loss, you may first feel a sense of shock and disbelief. Sadness, failure, anger, and self-blame often follow. Your partner may cope with their own feelings of loss in different ways.
It’s important to turn to loved ones and friends for support. Take care of yourself by eating healthy foods, getting rest, and staying active. Some people find it helpful to have a memorial for the baby they lost.
Joining a support group or talking to a grief counselor may help. At UPMC, we offer support to you and your loved ones during and after a pregnancy loss. We can also refer you to support services.