Pregnancy loss and miscarriage: what to expect

The NHS defines a miscarriage as the loss of a pregnancy before 24 weeks and notes that a miscarriage cannot be stopped once it has started. Tommy's explains that an early miscarriage is one that happens in the first 12 weeks, and a second trimester loss, sometimes called a late miscarriage, happens after 13 weeks and before 24 weeks.

Words used by clinicians can sound unfamiliar. Tommy's describes a missed miscarriage as one where the baby has died in the womb but there are no symptoms such as bleeding or pain, an incomplete miscarriage as one where the process has begun but some pregnancy tissue remains, and a chemical pregnancy as a very early loss, usually before 5 weeks.

People sometimes use the term threatened miscarriage for bleeding or pain in early pregnancy when the pregnancy continues.

The NHS says the main symptom is usually vaginal bleeding before 24 weeks, ranging from spots of pink, red or brown blood to heavy red bleeding that soaks through a pad. Other symptoms include pain and cramping in the lower tummy, pink, grey or white lumps from the vagina that may look or feel stringy, and fluid suddenly coming out.

Some people have no symptoms, and it is discovered at a scan. The NHS also reminds readers that vaginal bleeding and tummy pain in pregnancy can be caused by other things and are not always serious. If you are worried you can call your maternity unit, or NHS 111.

The NHS advises calling 999 if you are pregnant, have vaginal bleeding and you have severe tummy pain that stops you doing daily tasks, pain in the shoulder, feel sick, faint or dizzy or lose consciousness, or the bleeding is heavy and soaks a pad soon after putting it on. The NHS says these can be signs that you need immediate treatment.

It says to get urgent medical help for light bleeding or spotting with no or only mild pain, or for unusual vaginal discharge or fluid leaking. Call the maternity unit if you have the number. If you are under 20 weeks pregnant, an early pregnancy unit may be able to help, and if you cannot reach one, call NHS 111.

The NHS says doctors will ask about your pregnancy, previous pregnancies and general health, and may offer blood or urine tests and an internal (transvaginal) ultrasound scan. Scans and tests help the team understand what is happening with the pregnancy.

Waiting for answers can be very distressing. It is reasonable to ask the team to explain what each test can and cannot show, and what the next step will be.

The NHS says you will usually be offered different options depending on symptoms and how many weeks pregnant you are.

In the first 14 weeks the options the NHS lists may include no treatment and waiting for symptoms to pass, which usually takes about 2 weeks but can take longer; medicine to help you pass the pregnancy, after which you may go home or be monitored in hospital; or a procedure in which a thin tube is placed through the vagina into the womb to remove the pregnancy using gentle suction, under general or local anaesthetic, with the possibility of going home the same day.

Between 14 and 23 weeks the care team will discuss options, and you may need to give birth. Labour sometimes starts by itself, otherwise medicines may be given to start it, with a care team supporting you.

If you were at least 12 weeks pregnant and your blood type is D-negative, you may be offered an anti-D injection to help prevent a condition called haemolytic disease of the fetus and newborn in future pregnancies.

The NHS says everyone experiences miscarriage differently. After a miscarriage you may have tummy pain for a few days and vaginal bleeding or spotting that may last for up to 2 weeks. It suggests resting if needed, taking paracetamol for pain and talking to family or friends, and says not to have sex until symptoms have gone because of a risk of infection.

Emotional recovery may take longer than physical recovery. The NHS says you may feel many different emotions, including anxiety and sadness, and that counselling may be offered or can be requested through a GP or pregnancy unit. Support is also available for partners. The NHS says to contact a GP, NHS 111 or your pregnancy unit if you are worried about any of your symptoms.

Tommy's stresses that miscarriages very rarely happen because of something you did or did not do.

The NHS says it is not always known what causes miscarriage, but it is often because of a problem with the way the pregnancy develops. Tommy's says the most common cause of early miscarriage is problems with the baby's chromosomes, which happen by chance.

Factors that can raise the chance include age 35 or over, being from a Black African or Black Caribbean background, the baby's father being 45 or over, conditions such as polyendocrine metabolic ovarian syndrome, diabetes, blood clotting conditions or an underactive thyroid, a problem with the womb, low progesterone, vitamin D deficiency, smoking, heavy caffeine use, alcohol, obesity or being underweight, and exposure to harmful chemicals or air pollution.

Tommy's adds that there is a difference between risk and cause, and that there is nothing you can do to guarantee a healthy pregnancy, although some things can lower risk.

The NHS says you can try to get pregnant again when you feel ready, once symptoms have gone, and that it can take up to 8 weeks to have a period afterwards. Most women go on to have a successful pregnancy. Tommy's says most miscarriages are one-offs.

The NHS advises speaking to a GP after 3 or more miscarriages, which is called recurrent miscarriage. You will usually be referred for tests to find out whether there is a treatable cause and offered support. Tommy's says that when the cause is unknown, 6 out of 10 women who have had 3 miscarriages will go on to have a baby, and that most couples have a successful pregnancy next time.

Support organisations named by the NHS include Miscarriage UK and Tommy's, and local or online groups can help people who have been through the same experience.