Few experiences carry the heartache of a pregnancy ending in a miscarriage. Sometimes referred to as a spontaneous abortion, miscarriage is the term used for any pregnancy that ends on its own within the first 20 weeks of gestation. A miscarriage may leave a woman feeling as if she did something wrong or that somehow she caused it. However, in the overwhelming majority of cases this is simply not true. Most miscarriages are considered random events not likely to recur.

Most of the time, a specific cause for miscarriage cannot be identified, though up to 70 percent of first-trimester miscarriages, and 20 percent of second-trimester miscarriages, are caused by chromosomal anomalies. Other possible causes could include infection or exposure to environmental or industrial toxins. In some cases, the cause is diabetes, thyroid disease, or an autoimmune disorder. Very infrequently a woman will miscarry after undergoing a diagnostic test, such as amniocentesis. Physical trauma, incurred during a car accident or a fall down a flight of stairs, may cause a miscarriage. In other cases, substance abuse or smoking is to blame.

Studies tally 10 to 25 percent of all recognized pregnancies as ending in miscarriage. However, the total number of miscarriages may be greater still than that. Chemical pregnancies, for instance, occur when a pregnancy is lost shortly after implantation, resulting in bleeding around the time of a woman’s expected period. In many cases, a woman does not realize she has conceived when she expereinces a chemical pregnancy. In fact, many women learn they had a miscarriage during a routine prenatal visit. Sometimes no embryo is seen on ultrasound, or the embryo may be without a heartbeat.

What Do I Do?

Bleeding is often the very first sign of a miscarriage. About a quarter of all women, though, will experience some light vaginal bleeding (spotting, it’s called) during their first trimester so this is not highly unusual nor is it a sign of increased risk of miscarriage. If the bleeding is heavy, though, this may be a sign of miscarriage and you should see your health care provider. Other symptoms include cramps and fluid or tissue passing from the vagina.

While you are miscarrying, your bleeding will become heavy and the cramping will become painful. If you experience severe pain or if you are at risk of an ectopic (tubal) pregnancy — risk factors include a previous ectopic, current IUD use, prior pelvic infection, or infertility — you should seek medical help immediately. An ectopic pregnancy is a medical emergency.

In most cases there is nothing you can do once a miscarriage begins. Many women simply allow the miscarriage to complete itself naturally. Others schedule a procedure or take medication to help empty the uterus. Whether you miscarry naturally or with medication, the process may be over quickly or may take several days.

When Do I Save the Tissue?

If you have already had a miscarriage, it could be key to save the remains. What you will see will be blood as well as what appears to be lumpy-looking tissue, which could be the placenta. You may also see tissue resembling an embryo or fetus. Any tissue you find can be saved for testing, the results of which might help your doctor understand more and then help you prevent another miscarriage. If you are at home when you miscarry, you can put the tissue in a clean glass jar and refrigerate until you can bring it to your health care provider for testing. After the tests have been done, ask to see the pathology report.

Following a miscarriage, your bleeding will decrease over several days. Sometimes, though, a miscarriage comes with further complications. If your bleeding increases, if the blood remains bright red, if you have a fever, a smelly discharge, or persistent cramping, contact your health care provider.

Most doctors recommend waiting two weeks to prevent infections before you have intercourse following a miscarriage. Often, they recommend a repeat pregnancy test after a few weeks to make sure your hormone levels have returned to normal.