What is miscarriage?

Miscarriage is a pregnancy that ends spontaneously before 20 weeks or when the baby's weight is under 400gms and the baby dies. About one pregnancy in four miscarries and 99% of miscarriages occur in the first 13 weeks of pregnancy. Sometimes a doctor or nurse may refer to your miscarriage as a spontaneous abortion. Abortion is the common medical name for all pregnancies that end before 20 weeks. 82% of conceptions do not result in the birth of a live baby.

Why does miscarriage occur?

Most miscarriages occur because something went wrong during or soon after conception. There are thought to be many reasons which cause this, including:

• the fertilised egg may implant in the wrong place
• in many cases the part of the pregnancy that grows into the baby fails to develop
• something may be wrong with the placenta
• the mother's immune system may reject the placenta
• the mother may be sick, badly injured or under too much stress
• she may have a deformed uterus, a weak cervix or an intrauterine contraceptive device (IUCD) inside the uterus
• exposure to environmental chemical pollution, cigarette smoke, alcohol and recreational drugs.

What happens during a miscarriage?

Symptoms differ greatly depending on how advanced the pregnancy was and what caused the miscarriage. Threatened miscarriage may be experienced days or even weeks before you lose the baby. At this stage you may experience any of the following symptoms:

• light bleeding
• pain similar to period pain
• you may no longer feel pregnant and the tender breasts and nausea associated with pregnancy may disappear.

If you have any of these symptoms, talk to your doctor. In about half of these cases the symptoms settle down and the pregnancy continues as normal.

In miscarriage the cervix opens, the placenta comes away from the uterine wall and passes out of the vagina. The most common signs are:

• bleeding becomes heavy
• pain is like bad period pain or birth contractions
• faintness and nausea
• you pass pieces of placenta which look like blood clots or pieces of raw liver
• you may see the foetus
• if your miscarriage is due to an incompetent cervix and you are more than four months pregnant, the foetus may be alive.

What is an incomplete miscarriage?

An incomplete miscarriage occurs when some placenta remains inside the uterus. Most miscarriages occurring between six and 12 weeks are incomplete and your doctor will send you to hospital for a dilatation and curettage (D & C) operation. For this you will be given a general anaesthetic, your cervix opened and uterus completely emptied. Once the uterus is empty again the miscarriage is complete. The cervix closes, pain stops and bleeding slows down.

What is an ectopic pregnancy?

An ectopic pregnancy is one in which the foetus is growing in the wrong place, usually the fallopian tubes. Contact your doctor immediately if you have any of the following symptoms, as your life may be in danger and you may need an urgent operation:

• bad pains that do not feel like period pains
• dark bleeding which starts after the pain
• faintness, nausea, dizziness and vomiting.

What should I do if I think I am miscarrying?

• ring your doctor or local hospital and describe your symptoms. Remember, your doctor cannot prevent miscarriage
• ask your partner, a friend or relative to stay with you, preferably someone with a driver's licence and car who can take you to the doctor or hospital
• place a hot water bottle on your stomach to relieve pain. Take paracetamol or aspirin for bad pain
• soak up the blood with sanitary pads or towels. Lie down if you are bleeding very heavily
• pack an overnight bag for hospital, just in case you need it later
• if you need a D & C, do not eat or drink. Your stomach must be empty for the anaesthetic. Check this with your doctor
• save everything you pass in a bowl or bucket (rather than sitting on the toilet) to be seen by the doctor or tested to see why your miscarriage happened. If there was a small foetus, you can save it for burial. In some cases there is not a foetus or it is simply too small to find
• if you are alone and things are happening fast, dial 111 and ask for an ambulance. Never drive yourself to hospital if you are having a miscarriage.

See also: After miscarriage

Original material provided by Miscarriage Support Auckland Inc. Edited by everybody, March 2005.