Patient education: Pregnancy loss (The Basics)

What is pregnancy loss? — This is the medical term for when a pregnancy ends before a person has been pregnant for 20 weeks. (A normal pregnancy lasts about 40 weeks.) Pregnancy loss is also called "miscarriage."

To understand pregnancy and pregnancy loss, it can help to know these terms:

●Uterus – This is the part of your body where a pregnancy grows (figure 1).

●Embryo – This is the group of cells that starts growing when a person gets pregnant.

●Fetus – At about 10 weeks of pregnancy, the embryo becomes a fetus. This is what it is called up until birth.

What causes pregnancy loss? — Most of the time, when a person has a pregnancy loss, it is not because of anything they did.

Pregnancy loss can happen if:

●The embryo begins to develop but then stops growing – This is often due to genetic problems.

●The pregnant person has certain medical problems – Examples include diabetes that is not well controlled or an abnormal uterus shape.

What are the symptoms of pregnancy loss? — The most common symptoms are bleeding from the vagina and belly pain or cramping. See your doctor or nurse right away if you are pregnant and have these symptoms. If you are not sure if you are pregnant, take a home pregnancy test.

You should also see your doctor or nurse if you are pregnant and:

●You have a fever of 100°F (37.8°C) or higher.

●Anything solid comes out of your vagina.

●Thick fluid that smells bad comes out of your vagina.

If you cannot talk with your doctor or nurse, or if you have heavy bleeding (soaking a pad in 1 to 2 hours), go to the emergency department.

These symptoms do not always mean that you are having a pregnancy loss. Your doctor or nurse can help figure out if anything is wrong.

Will I need tests? — It depends. Your doctor or nurse might be able to tell if you have had a pregnancy loss just by asking you questions and doing a pelvic exam.

They might also look at your uterus by doing an ultrasound. This test uses sound waves to create pictures of the inside of your body. It lets the doctor look at the embryo or fetus and check for heart activity. If they can see heart activity, this means that you have not had a pregnancy loss.

You might also need a blood test and then another blood test several days later to check on your pregnancy.

How is pregnancy loss treated? — It is not possible to stop a pregnancy loss that has already started. If you have had a pregnancy loss, the pregnancy tissue needs to leave your body. Your options include:

●Waiting to let it exit through your vagina by itself

●Medicine to help it exit your vagina

●Surgery to remove it from your uterus

In most cases, you get to decide. Your doctor or nurse will talk to you about each option to help you decide.

This is a very personal choice. Some people prefer to wait and let things happen naturally. Other people prefer specific treatment so they can have a better idea of what to expect and how long it will take. Sometimes, depending on your situation, 1 or more of these might not be an option.

If you have a negative blood type (for example, "O negative"), you might need a special injection to help prevent problems in future pregnancies. If you don't know your blood type, ask your doctor or nurse to check.

Can I prevent pregnancy loss? — There is no way to make sure that you will not have a pregnancy loss. But there are some things that you can do during pregnancy to lower your chances of having one:

●Avoid tobacco products (including vaping), alcohol, cocaine, and other substances. Try to avoid injury to your belly.

●Certain infections increase the risk of pregnancy loss. Your doctor or nurse can talk to you about how to prevent these.

●Some of the invasive tests used to check on a fetus during pregnancy can, in rare cases, cause pregnancy loss. If your doctor or nurse suggest any of these tests, ask whether the test could increase the risk of pregnancy loss.

●Some medicines or other treatments can harm a fetus. Talk to your doctor or nurse before taking any medicines. This includes prescription medicines, over-the-counter products, herbs, and supplements. If you are pregnant and your doctor or nurse recommends a medical treatment or X-ray, ask if it could hurt your fetus.

If you have had a pregnancy loss in the past and you want to get pregnant again, your doctor or nurse might suggest taking daily prenatal vitamins and low-dose aspirin before and during your next pregnancy. This might lower your risk of having another pregnancy loss. Aspirin is not usually recommended for people who have not had a past pregnancy loss, or for people who have never given birth before. Do not take aspirin or any other medicines unless your doctor, nurse, or midwife tells you that it is safe.

What do I do after a pregnancy loss? — After a pregnancy loss, it's important to take care of yourself. This includes both your physical and emotional health.

●Physical – After a pregnancy loss, your doctor or nurse will probably tell you not to have sex or put anything in your vagina for 2 weeks. This might help lower the risk of infection. If you plan to start birth control, they can talk to you about when and how to do this.

Get plenty of rest, and let other people help you if possible. When you feel ready, it can help to get physical activity. Even gentle activities, like walking, are good for your health.

●Emotional – It's normal to feel sad or anxious or have other emotions after a pregnancy loss. Some people feel shock, numbness, or emptiness. Others feel guilt, fear, confusion, or relief. There is no right way to feel, and your feelings might change each day.

Try to be gentle with yourself. Talking to loved ones or others who have had a pregnancy loss can help.

If you are struggling or think you might be depressed, tell your doctor or nurse. There are treatments that can help.

Can I have a normal pregnancy after a loss? — Probably. People who have had a pregnancy loss are somewhat more likely than those who have not to have another loss. But most people who have a pregnancy loss are able to have a healthy pregnancy in the future.

Your doctor will tell you if you should wait before trying to get pregnant again. In most cases, it's safe to start trying again as soon as you feel ready. But it's normal if it takes some time for you to feel ready again.

If you have 3 or more pregnancy losses, your doctor might want to do some tests to try to figure out why.

More on this topic

Patient education: Coping after pregnancy loss (The Basics)
Patient education: Repeat pregnancy loss (The Basics)
Patient education: Bleeding in early pregnancy (The Basics)
Patient education: Cervical insufficiency (The Basics)

Patient education: Pregnancy loss (Beyond the Basics)