What is a miscarriage?

A miscarriage is pregnancy loss before 20 weeks of pregnancy. If your baby dies after 20 weeks of pregnancy, this is called a stillbirth.

Up to 1 in 4 pregnancies end in miscarriage before 10 weeks of pregnancy.

Common symptoms of miscarriage are:

• cramping lower abdominal pain, similar to period pain
• vaginal bleeding

Around 1 in 4 females experience vaginal spotting or bleeding in the first trimester. This does not always mean you are having a miscarriage.

If you are concerned that you are having a miscarriage, see your doctor or midwife for advice and support.

If you are alone, consider calling your partner or a friend for help and support.

What are the symptoms of a miscarriage?

The most common sign of a miscarriage is vaginal bleeding, which can vary from light red or brown spotting to heavy bleeding. If it is very early in the pregnancy, you may not realise that you were pregnant, and think that the bleeding is due to your period.

Other signs may include:

• cramping pain in your lower abdomen, which can vary from period-like pain to strong labour-like contractions
• passing fluid from your vagina
• passing of blood clots or pregnancy tissue from your vagina

What will happen if I go to hospital with a miscarriage?

If you go to your hospital's emergency department, you will be seen first by a triage nurse, who will assess how urgently you need to see a doctor. Depending on your symptoms, the staff may take you in to see a doctor immediately or they may ask you to wait.

If you are waiting to see a doctor or nurse and your symptoms become worse or you feel like you need to go to pass a bowel motion (poo), let the staff know immediately.

What are the types of miscarriage?

There are several types of miscarriage. Other types of pregnancy loss include an ectopic pregnancy, molar pregnancy and a blighted ovum.

Threatened miscarriage

A 'threatened miscarriage' is when you have symptoms such as light vaginal bleeding or lower abdominal pain, but your cervix remains closed. This may last for days or weeks.

The pain and bleeding may improve, and you may go on to have a healthy pregnancy and baby, or your cervix may open and you may go on to have a miscarriage.

There is nothing a doctor, midwife or you can do to prevent a miscarriage. In the past, bed rest was recommended for a threatened miscarriage, but there is no scientific proof that this makes a difference.

Inevitable miscarriage

An inevitable miscarriage is a miscarriage that has already started. You will have vaginal bleeding and strong lower stomach cramps. Your cervix will be open and the pregnancy tissue will start to come away in the bleeding.

Complete miscarriage

A complete miscarriage has taken place when all the pregnancy tissue has left your uterus. Cramping pain, similar to strong period pain, is common as the uterus contracts to empty its contents.

Vaginal bleeding may continue for several days but should become lighter after the uterus is empty.

If you have miscarried at home, you should have a check-up with a doctor or midwife to make sure the miscarriage is complete, to prevent infection.

Incomplete miscarriage

An incomplete miscarriage is when some pregnancy tissue has passed, but some pregnancy tissue remaining in the uterus. You may have ongoing vaginal bleeding and lower abdominal cramping as the uterus continues tries to complete the miscarriage. In some cases, your symptoms may have stopped.

If some pregnancy tissue remains in your uterus, there is a chance that you will develop an infection.

Your doctor or midwife can assess you and advise whether or not medicine or surgery is recommended to complete the miscarriage.

Missed miscarriage

Sometimes, the pregnancy ends without you having any symptoms of miscarriage. This is known as a 'missed miscarriage'. You may be shocked to have a routine scan and be told that you are no longer pregnant.

Symptoms of pregnancy, such as nausea and tiredness, may have reduced, or you might not have noticed any change.

If this happens, you should discuss treatment and support options with your doctor.

Recurrent miscarriage

Some people experience repeated miscarriages. If you have had 3 or more miscarriages in a row, it's best to discuss this with your doctor. They may recommend investigating the possible causes and/or referring you to a specialist.

How is a miscarriage treated?

Your doctor will ask you about your symptoms and may examine you. You will usually have an ultrasound to confirm a miscarriage and check what type it is.

Based on their findings, your doctor will discuss the options for managing the miscarriage. There are many options with different benefits and risks.

Expectant or natural management

Also called 'watch and wait', this option involves going home and waiting for the pregnancy tissue to pass naturally. This may happen quickly, or it may take a few weeks. If you are still having pain and bleeding after 2 weeks, go back to your doctor. Your doctor will usually organise a follow up to check that the miscarriage is complete, and you have passed all the pregnancy tissue.

Medical management

You may be offered medicine that speeds up the passing of the pregnancy tissue. This medicine is called misoprostol. It works by encouraging the cervix to open and your uterus to contract.

You may experience heavy bleeding, pain and nausea. Your doctor can give you medicine to help with these symptoms. Your doctor may recommend that you stay in hospital until the tissue has passed, or you may be able to go home.

Surgical management

You may be offered or recommended to have minor surgical procedure called a 'dilatation and curettage' (also called a D&C or a curette). This procedure is often recommended if you have heavy bleeding, significant pain or signs of infection. It may also be a good option if expectant or medical management has failed. You may also decide that you prefer this option if you don't want to see the pregnancy tissue.

You will have this procedure under general anaesthesia in an operating room. The actual procedure takes 5 to 10 minutes once you are asleep. The doctor opens your cervix and removes the remaining pregnancy tissue.

What happens if I miscarry at home?

Some people miscarry at home before they have a chance to see their doctor or get to the hospital.

If this happens, then:

• use pads to manage the bleeding
• if you choose to, you can save any pregnancy tissue that you pass. You can bring it to your doctor for testing to try and identify a cause of the miscarriage.
• take medicines, such as paracetamol, if you have pain
• rest
• speak to your doctor or midwife

There is a chance you may see your baby in the tissue that you pass. However, often the baby is unformed or too small to recognise. It is normal to want to look at the remains, but you may decide you do not want to. There is no right or wrong thing to do.

Some women miscarry while on the toilet. This can also happen if you are out and about, or in hospital. There is no right or wrong way to handle this.

You may have a strong emotional response to having a miscarriage — this is normal. Speak with your partner or a family member, reach out for emotional support or seek professional help if you feel you need it.

If you think you have had a complete miscarriage at home, you should see your doctor for a check-up. Your doctor may refer you for an ultrasound to make sure you passed all the pregnancy tissue.

Why do miscarriages happen?

You may wonder why the miscarriage happened. In most cases, a miscarriage has nothing to do with anything you have or have not done. There is no evidence that exercising, stress, working or having sex causes a miscarriage.

Most parents do not ever find out the exact cause. Miscarriages often happen because the baby fails to develop properly, usually due to an abnormality that happens randomly, that is not inherited. Chromosomal testing in not routinely performed after a miscarriage.

Occasionally, miscarriage is caused by:

• autoimmune conditions
• hormonal problems
• blood clotting problems
• thyroid problems
• uncontrolled diabetes
• severe infections causing high fevers (not common colds or other common infections)
• physical problems with your uterus (womb) or cervix, such as fibroids

What are the risk factors for miscarriage?

You are more likely to have a miscarriage if you:

• are older
• smoke
• drink alcohol in the first trimester
• drink a lot of caffeine in coffee, tea or energy drinks (more than 500mg, or about 3 – 5 cups of coffee, per day)

If you have had 3 previous miscarriages, your doctor may recommend testing to check for a cause.

Can I prevent a miscarriage?

Often a miscarriage happens either for no known reason, or for no preventable reason. Nothing can be done to prevent miscarriage from happening if a pregnancy is developing abnormally.

A healthy lifestyle gives you the best chance to have a healthy pregnancy. If you are pregnant or trying to fall pregnant you should avoid cigarettes, alcohol and limit your caffeine intake to decrease your risk of miscarriage. It's also a good idea to avoid contact with people who have a serious infectious illness when you're pregnant.

Resources and support

Speak to your doctor or midwife for information and advice on what do and how to look after yourself if you have a miscarriage.

Red Nose Grief and Loss provides support for miscarriage, stillbirth and newborn death. Call their support line on 1300 308 307, available 24 hours a day.

NSW health has a booklet about miscarriage in many community languages.

The Pink Elephants provide information and peer-support for anyone impacted by early pregnancy loss.