Pregnancy: Miscarriage

iscarriage can leave a couple severely shaken as the anticipation of having a baby suddenly turns to grief over a loss. Many feel devastated and guilty even if the miscarriage occurs during the early weeks or months of the pregnancy. However, while it's normal to blame some specific act or situation, miscarriages are rarely triggered by factors under the partners' control.

Exercising, a minor fall, or sexual intercourse does not typically cause a miscarriage. The fetus is well protected by the mother's bones and muscle as well as by the amniotic fluid in which it floats. There is also no evidence that conceiving while taking birth control pills increases the risk of miscarriage. Becoming pregnant while using an IUD, however, does make you more likely to miscarry or develop an infection.

As many as 30 percent of all pregnancies end in miscarriage, half of them before the woman even realizes she is pregnant. Fortunately, most women who miscarry, even more than once, can become pregnant again and give birth to a healthy baby. If you have had a miscarriage and want to try again, work with your doctor to learn the reason for the loss and to plan future pregnancies. Closely monitored pregnancies are especially important for women who have miscarried.

Your doctor may refer to a miscarriage as a “spontaneous abortion,” since “abortion” is the medical term for any interrupted pregnancy. A miscarriage, or spontaneous abortion, is the loss of a pregnancy before the fetus can survive outside the womb, usually within the first 20 weeks.

Warning Signs

Any bleeding from the vagina during pregnancy suggests the possibility of miscarriage. Call your doctor about any abnormal vaginal bleeding, even if you do not think you are pregnant. Bleeding or spotting may be the first sign that you are pregnant and that the pregnancy is at risk. Staining or bleeding does not necessarily mean that you will miscarry, however. About 20 to 25 percent of pregnant women have some spotting or bleeding early in pregnancy, and about half of these pregnancies continue successfully.

Bleeding that signals possible miscarriage is usually light. It can be brown or bright red and may occur repeatedly over many days. If the bleeding persists or increases, the chances of losing the baby are higher. Mild pain, such as cramping or low backache, usually develops at some point after the bleeding has started. Some women experience severe abdominal pain and dizziness.

If you have been bleeding and an ultrasound scan (sonogram) indicates that the fetus is alive, your doctor probably will ask you to rest in bed as much as possible. Avoid sexual activity. The doctor will monitor you to be sure that bleeding and cramping remain mild, that the cervical canal from the uterus stays closed in order to retain the baby in the uterus, that sonograms continue to show fetal heart movements, and that the fetus is growing. More than 90 percent of first­trimester pregnancies continue when ultrasound scans indicate that the baby is alive.

Rarely, early in pregnancy, fluid is suddenly released from the vagina without bleeding or pain. If you experience this, call your doctor immediately. You will probably be instructed to stay in bed and watch for further leakage, bleeding, cramping, or fever. If, after a few days, you have none of these things, your doctor may tell you that it is safe to go back to daily activities. Avoid intercourse and any other vaginal penetration. If you do develop bleeding, pain, or fever, however, miscarriage may be inevitable.