No one likes to talk about pregnancy loss. Excited couples come for their first sonogram to see the baby’s heartbeat. Sometimes, these visits end with tragic news, a miscarriage 

A miscarriage goes by many names chemical pregnancy, early pregnancy loss, miscarriage, or spontaneous abortion. Regardless of what we call it, women feel a profound loss and want answers. 

How common is early pregnancy loss?

Miscarriages are common affecting 10-20% of known pregnancies. Some miscarriages occur before a woman even realizes she is pregnant. As many as half of all pregnancies may end in miscarriage. 

The risk increases as a woman ages. Early pregnancy loss occurs in more than one-third of pregnancies in women older than 40 years.

What causes miscarriage?

About one-half of early pregnancy losses are due to genetic problems. These are due to a random genetic error when the sperm fertilizes the egg. During fertilization, the embryo ends up with an abnormal number of chromosomes, the cellular structures that carry genes. 

Sperm and egg cells each have 23 chromosomes. When they come together during fertilization, a normal embryo should have a total of 46 chromosomes. 

If the embryo ends up with an abnormal combination of chromosomes it can not develop. Miscarriage is the result. 

How can I avoid a miscarriage?

When women experience a pregnancy loss they often look to assign blame. They feel guilty and wonder what they did wrong. 

It is important to know. We can not make ourselves miscarry. 

Working, exercising, lifting things, having sex, getting angry, or feeling sad does not cause early pregnancy loss. 

Some behaviors may increase the risk of miscarriage. Tobacco, alcohol, and drug use must be avoided. Any medications should be reviewed with your Obgyn. 

Consuming 200 mg or less of caffeine a day (the amount in two cups of coffee) does not appear to increase the risk of early pregnancy loss.

How do I know if I am having a miscarriage? 

Bleeding and cramping are the most common symptoms of early pregnancy loss. Up to 50% of first-trimester pregnant women experience some amount of bleeding. First trimester bleeding is common, but never normal. Obgyns always want to evaluate a pregnant woman who is bleeding. 

Most of the time, early pregnancy bleeding resolves, and the pregnancy continues without a problem. Bleeding and cramping can be signs of other pregnancy problems, such as miscarriage, subchorionic hematomas, and ectopic pregnancy. 

How do doctors diagnose a miscarriage?

The first step in evaluation is a physical exam. Next, an ultrasound exam will be done to confirm there is a live baby located inside of the uterus. 

If the pregnancy is too early to be visualized by ultrasound, the doctor may monitor the hormone levels. Typically, bHCG and progesterone are used to track early pregnancy. 

What is the treatment for miscarriage?

When a woman has a pregnancy loss, the remaining tissue must be removed from the uterus. In some cases, this will happen naturally. A woman will experience bleeding and cramping and expel the tissue. 

In other cases, medication can be used to help pass the tissue. When medication is used, bleeding is heavier than a menstrual period. Cramping pain, diarrhea, and nausea are common. 

Often women choose a minor surgery called a dilation and curettage (D&C). In a D&C, the cervix is dilated, and an instrument is used to remove the pregnancy tissue. A D&C usually is done in an ambulatory surgical center. General anesthesia or regional anesthesia may be used.

Will a miscarriage prevent me from getting pregnant in the future?

Most women who experience a miscarriage will be able to get pregnant in the future with no complications. One miscarriage does not mean something is wrong. 

Testing can be done for those with repeated pregnancy losses to evaluate for an underlying cause. 

When can we try again after miscarriage? 

The first period is often disrupted after a miscarriage. Ovulation occurs about two weeks after the BCHG drops to zero. 

If you want to get pregnant, you can start trying right away. 

If you do not want to get pregnant, please consider one of the many available birth control options. 

This article was contributed by MacArthur Medical Center’s Dr. Rebecca Gray.