Having your pregnancy end in a miscarriage can be very sad. If you do have a miscarriage, it is unlikely that you did anything to cause it. There is a good chance that you will be able to have a baby the next time you try.

What is a miscarriage? A miscarriage is the loss of a pregnancy before the 20th week of pregnancy. The medical term for miscarriage is spontaneous abortion. About 20% (1 in 5) of all pregnancies end in miscarriage, mostly during the first 13 weeks of pregnancy.

How does it occur? Most miscarriages are caused by genetic problems where the baby develops abnormally or not at all. In such cases, miscarriage is the body’s way of ending a pregnancy that is not developing normally. Other possible causes of miscarriage include infections, diabetes, hormonal imbalances, and defects in the uterus. Excessive cigarette smoking, alcohol, and illegal drugs such as cocaine can also cause miscarriage.

A fall by the mother seldom causes miscarriage. The baby is well protected within the uterus. In addition, there is no evidence that emotional stress or physical or sexual activity causes miscarriage in a normal pregnancy.

What are the symptoms? Possible symptoms include:

1. Bleeding from your vagina. The amount of bleeding can range from a few drops of blood to a heavy flow. The bleeding may start with no warning or you may first have a brownish discharge.

2.  Cramping pain in your lower abdomen.

3.  A gush of fluid from the vagina without bleeding or pain. This may mean that your membranes have ruptured (your bag of waters has broken).

4.  You may notice some solid material passing out of your vagina. Try to keep this so your doctor can examine it.

It is also possible that you may have no bleeding or pain, but the fetus has died and symptoms of early pregnancy have disappeared. This condition is called a missed miscarriage (or missed abortion).

How is it diagnosed? Your provider may do a pelvic exam and an ultrasound scan to diagnose a miscarriage. If you have what is called a “threatened miscarriage,” you haven’t actually miscarried yet and there is a chance that your pregnancy will continue. You may have a small amount of bleeding from your vagina early in your pregnancy, and maybe some cramping, but your cervix stays closed. Your doctor may ask you to rest and avoid sex for a few weeks. Often the bleeding will stop and your pregnancy will continue normally. An “inevitable miscarriage” means that nothing can be done to prevent the miscarriage. Miscarriage becomes inevitable if the bleeding and cramping continue and the cervix begins to open, or if the fetus has died.

What is the treatment? If nothing is done with an inevitable miscarriage, most of the time the uterus expels its contents entirely, but sometimes only part of the tissue comes out, or you may even have to wait many weeks for the body to expel the pregnancy. For an inevitable miscarriage, your health care provider can speed the process with a medicine called misoprostol, so that the uterus will contract and expel the pregnancy sooner. Another option is vacuum aspiration, which is a medical procedure where the cervix is stretched open and tissue is gently scraped or suctioned from the lining of your uterus. In most cases, this can be performed in your doctor’s office.

What are the risks associated with a miscarriage? The risks with a miscarriage are bleeding or infection. If your blood type is RH negative, you will need a Rhogam shot to prevent problems in future pregnancies. How soon can I start trying to get pregnant again? Wait to have sexual intercourse until 2 to 4 weeks after a miscarriage. Doctors usually recommend that you wait until you have had at least one normal period before you try to get pregnant again.

Did I do anything to cause the miscarriage?  Do not blame yourself for the miscarriage. It is rare that the miscarriage was caused by anything you did. For example, miscarriages are not caused by sexual intercourse or strenuous exercise.

Grief, anger, and feelings of guilt are common and completely normal reactions to a miscarriage. Allow yourself to grieve over the loss of the baby. Many people find a burial ritual or “funeral” to be helpful. Seek support from friends. You may find it helpful to talk to others who have had miscarriages.

You may be afraid that your miscarriage means that you won’t be able to have a baby. Remember, however, that for most women the next pregnancy is normal. If you have three or more miscarriages, however, it is important to be tested to determine and treat the cause.

 What happens after a miscarriage?  Your recovery will take 4 to 6 weeks.  You may have some spotting and cramps for a few days.  If you were pregnant for more than 13 weeks before the miscarriage, you may still look pregnant and your breasts may still leak milk.  Low-impact exercises, such as walking or swimming, will not hurt you.  Gradually exercise more as you feel better.  Usually your doctor will see you in a couple of weeks to check your recovery.

When should I call my doctor? If you are pregnant and have bleeding from your vagina, with or without pain, call your doctor. If the bleeding is heavy or you have severe pain, see your doctor immediately. If you are recovering from a miscarriage, call your health care provider immediately if you have any of these symptoms: heavy bleeding, fever, chills, severe abdominal pain.