Doc Talk: Miscarriages

Miscarriages, also called early pregnancy losses, are often not talked about enough in our society, even when 1 in 4 women have experienced a miscarriage in their life. Many women wonder what they might have done wrong, or what they could have done to prevent it. It is important to know that if you have suffered from a miscarriage, you are not alone, and miscarriages are no one’s fault. To help answer questions regarding miscarriages, we spoke to Women’s Health Connecticut’s Chief Medical Officer, Dr. Matthew Saidel.

What is a miscarriage and how common are they?

A miscarriage is defined as a loss of a pregnancy due to natural causes before 20 weeks of pregnancy. After 20 weeks, a miscarriage is medically known as a stillbirth, and it has a different set of causes and management. We think of pregnancies as these perfect things, but I tell patients the process of fertilization is very complicated and is designed to make mistakes.

It is important for people to know that miscarriages are much more common than we think. Of known pregnancies, about 10 to 20% result in miscarriages. Of unknown pregnancy, that number increases to 50%, as many miscarriages occur before a woman even realizes she is pregnant.

Why does a miscarriage happen?

The causes for miscarriages vary, but almost 50% of the time it is something wrong with the genetic materials, like missing or extra chromosomes in the fetus. At the time of fertilization, when the sperm and egg combine, these genetic mistakes sometimes happen, causing a miscarriage. The other 50% of the time we really don’t know why. However, we know that with advanced maternal age, women are at a higher risk of having miscarriages.  Although these genetic “mistakes” can cause a miscarriage, they can also be good things, producing new traits that make us stronger or more resistant to disease.  They help us evolve as a species.  If there were no mistakes, we would all be perfect amoebas. 

When a patient comes in for a preconception visit, we talk about the risk of miscarriages and that it is a natural part of the process. It’s also important for those who have had or are going through a miscarriage to understand they are not alone, and there is nothing you could have done to do this and there is nothing you could have done to prevent it.

What are some of the signs of a miscarriage?

Common signs include abdominal pain or cramping, vaginal spotting or bleeding, back pain, weight loss, feeling light-headed, and tissue or fluid passing from the vagina. Keep in mind that vaginal spotting is common in the first trimester—if you happen to notice spotting in the early months of your pregnancy, this doesn’t mean you are experiencing a miscarriage. That said, it’s still important to get in touch with your provider if you experience any of these symptoms.

What is a silent miscarriage?

A silent or missed miscarriage is also very common. Of the first 20 cells of pregnancy, only 3 or 4 will be the fetus, the rest are supporting structures like the placenta, the membrane, and the amnionic fluid. Most of the body’s signs and symptoms of pregnancy come from those supporting structures. Sometimes when the fetus does not form the supporting structures will remain in the uterus, making your body go on like it was still pregnant and you won’t have the normal symptoms of a miscarriage.

What happens when I have a miscarriage?

There are three ways a miscarriage is managed. One is expectant management, where the embryonic tissue will pass naturally causing a miscarriage. The second is surgical management called Dilation and curettage (D&C), where the doctor will surgically remove the remaining tissue from the uterus. The third is medical management, where we use certain medications to make the uterus contract to pass the remaining tissue to complete the miscarriage.

What happens after I have a miscarriage?

The impact of a miscarriage isn’t just physical. From a physical standpoint, the body will be okay within a few days, and you can start trying to conceive relatively quickly after a miscarriage. However, the emotional toll will take much longer. When people learn they are pregnant they start to build a concept of family and the life that they will have, and their child will have. When a miscarriage occurs, that dream ends very abruptly and the pain of a miscarriage heals, but it heals with a scar. Everyone deals with this differently, but if your grief is long-lasting, we recommend getting in touch with a mental health specialist to help. Women’s Health Connecticut providers are equipped to give anyone suffering from the loss of a miscarriage the resources they need.

If you had a miscarriage, please know you are not alone. If you are emotionally or physically struggling after having a miscarriage, please speak with your provider so you can get the support you need. If you would like to learn more about miscarriages, here are some resources: