Signs of Miscarriage

The medical term for miscarriage is “spontaneous abortion”. It doesn’t mean that you intentionally ended the pregnancy but instead means that, sometime before the 20^th week of your pregnancy, the pregnancy was lost.  If you lose your pregnancy, it is not called a miscarriage but is instead referred to as a “premature birth” or “preterm birth”.

Miscarriages are extremely common.  Most research studies indicate that about 30 to 40 percent of the time, an egg is fertilized but the egg does not divide or divides to a certain point in pregnancy but, due to various reasons, the pregnancy cannot continue.  Most of the time, the miscarriage occurs before you actually know you are pregnant and the pregnancy is lost within the first few days after conception.

If the pregnancy is lost within a few days of conception, you might not experience signs or symptoms that are any different from having a regular period. The period may be heavier or may happen a few days later than expected but it will be so similar to a regular period that you don’t feel any different and won’t have pregnancy symptoms.

The HCG levels in this type of pregnancy may be so low that you won’t even have a positive pregnancy test.  You need to have implantation and the mixing of embryonic blood and maternal blood in order to see a rise in HCG levels, which is what a pregnancy test is based on.

Causes of Miscarriage

Contrary to popular belief, miscarriages are rarely due to something the pregnant woman did or something she didn’t do during the earliest stages of the pregnancy.  If you have a miscarriage, this is no time to blame yourself for the pregnancy loss.  You can’t have a miscarriage just because you had sex in the first trimester of pregnancy, exercised too much, or drank coffee to a moderate degree.

The most common cause of miscarriage, according to the American Pregnancy Association, is a genetic or chromosomal abnormality.   This means that, during the fertilization process, the blending of male and female DNA led to having a missing chromosome in the fertilized egg, an extra chromosome in the fertilized egg or a severely abnormal chromosome that meant the embryo was nonviable from the very beginning.

In such cases, the fertilized egg may not be able to divide more than a few times and you’ll have a miscarriage very early on in the pregnancy. Some chromosome abnormalities, such as Trisomy 21 and Trisomy 18, are not as bad as other types of chromosome abnormalities and the egg divides many times, creating an embryo that doesn’t miscarriage until later on in the pregnancy, usually in the first trimester.  You’ll have a positive pregnancy test and will have symptoms of pregnancy but the pregnancy will be lost prior to the 20^th week of the pregnancy.

Even though most miscarriages are completely out of your control, there are some things that can contribute to having a miscarriage that are in your control.  If during the pregnancy, you smoked too much, used illicit drugs, drank too much alcohol, or at undercooked meat (a major cause of Listeriosis in pregnancy), you might be contributing to having a miscarriage.

Other things that may cause a pregnancy loss in the first 20 weeks include having a structural problem with your uterus that prevents adequate fetal growth, low progesterone levels, trauma (such as being in an automobile accident or falling from a great height), Lyme’s disease, Fifth disease, a chronic illness (such as Crohn’s disease, hypothyroidism, diabetes, or lupus), or are older than 35 years of age.  Most of these things are considered out of your control but can lead to miscarriage if they are present in pregnancy.

Miscarriage Symptoms You Should Be Aware Of

Even though you may not be able to prevent a miscarriage, you should know the various signs and symptoms of a miscarriage so you can get the proper care during this trying time. You should call your obstetrician or midwife if you have any of the following symptoms:

• Bleeding or spotting 

While you can have spotting or bleeding in a normal pregnancy (due to slight bleeding from the placenta or bleeding from implantation, one of the most common signs of an impending miscarriage is some type of spotting or bleeding. It usually starts out slight, with just pink-tinged vaginal discharge but then, rather than going away, the spotting gets worse and you have bleeding that can be greater than the amount of bleeding you have in a normal period.  If you have severe bleeding that soaks through a heavy pad in one hour or less, this could be a medical emergency and you should go to the emergency room for evaluation and treatment. Once you have heavy bleeding, the miscarriage is usually inevitable and there is nothing you can do to stop the pregnancy loss.

• Cramping

Cramping is another symptom that can happen in a normal pregnancy or a miscarriage.  You can get cramping pain from stretching of the uterus in a normal pregnancy or from “round ligament pain”, which is stretching of the ligaments that tether the uterus to the rest of the pelvis.  If you get cramping because of this, it doesn’t mean you are having a miscarriage and is part of the normal process. Cramping, however, could be a sign of a miscarriage. The cramping may be similar to those cramps you feel in a normal period but, if a miscarriage is occurring, the cramping tends to become increasingly severe and will usually be accompanied by other symptoms, such as spotting and bleeding.  If you experience cramping as part of your pregnancy, it may not be cause for alarm but, if the cramping is severe, you should see your doctor to find out if it is a normal thing or part of having a miscarriage.

• Back pain

Not every woman has cramping pain felt in the lower pelvic region.  Cramps in some women are felt in the back and are experienced as a moderately severe pain in the lower part of the back.  Back pain alone without any other symptoms rarely means you are having a miscarriage but, if you are having dull low back pain associated with other miscarriage symptoms, such as spotting or bleeding, you need to see your obstetrician or midwife for further evaluation to determine if the pain means anything or is just a part of a normal pregnancy.

• Vaginal discharge

Some miscarriages have, as the first noticeable symptom, an increase in vaginal discharge.  The vaginal discharge can be pink from a small amount of bleeding mixed in with the normal discharge you find in pregnancy.  It can also show itself as a gush of fluid, although this type of vaginal discharge usually happens after the 20^th week of pregnancy, indicating a preterm birth rather than a miscarriage.  Because increased vaginal discharge can be a normal sign of pregnancy, the finding of increased or abnormal vaginal discharge doesn’t necessarily mean you are having a miscarriage.  If you have vaginal discharge that smells bad or is associated with irritation of the vaginal tissues, it could mean you have some type of sexually transmitted disease that could mean you will have a miscarriage from an untreated infection.  Any time the vaginal discharge becomes bloody, associated with cramping, or is foul smelling, you should see your doctor or midwife as this could indicate an impending miscarriage.

• Loss of Symptoms of Pregnancy

If you are in your first trimester and have the typical pregnancy symptoms, such as nausea, vomiting, or breast tenderness and the symptoms go away, it can mean that you have a normal pregnancy but that the hormone levels have become more stable.  It can also mean that the HCG levels are dropping and you are inevitably going to have a miscarriage.  If the only symptom you have is a decrease in pregnancy symptoms, this may mean nothing; however, if you get other symptoms, such as cramping and bleeding, it is time to see your doctor or midwife in order to have an ultrasound to evaluate the pregnancy for a possible miscarriage.

• A negative pregnancy test after having a positive pregnancy test

If you had a positive pregnancy test earlier on in pregnancy and are worried enough about the pregnancy, you may decide to take a repeat pregnancy test. If the test turns up negative, it may mean you are having a miscarriage.  The pregnancy test measures the HCG levels in the maternal urine or blood and, if the pregnancy is going to end in miscarriage, the HCG levels may be falling to such a degree that you no longer have a positive test.  The peak HCG levels are between 8 and 10 weeks into the pregnancy so, if you have a negative pregnancy test around this time, you should call your doctor or midwife in order to have an ultrasound to see if it means you are having a miscarriage.

Some of the signs of a miscarriage can be found in a regular pregnancy as well so, if you think you might be having a miscarriage because you are experiencing symptoms, it is worth your peace of mind to see your doctor or midwife to have the pregnancy checked out for the possibility that your symptoms are due to an impending miscarriage.

References:

1. Signs of miscarriage. http://www.parenting.com/gallery/signs-miscarriage
2. Miscarriage: Causes, Signs, and what to Expect. http://www.parents.com/pregnancy/complications/miscarriage/understanding-miscarriage/