Pregnancy Loss (Miscarriage)

If a pregnancy is lost before 20 weeks gestation, it is called a miscarriage.  Approximately 20% (1 out of 5) of all pregnancies will end in a miscarriage; and despite medical advances, we have been largely unsuccessful in lowering the chance of pregnancy loss. The good news is that a woman, who has had one miscarriage, has no greater chance of miscarriage in the next pregnancy – the risk of pregnancy loss remains 20%. Unfortunately, two or more miscarriages in a row can occur.  Three or more miscarriages in a row is considered recurrent pregnancy loss, and needs to be evaluated to see if a cause can be found.  Even in these cases, the chance of finding a treatable cause is low; and the chance of a successful pregnancy in the future is 60-70%.

Most of the time, the cause of a pregnancy loss cannot be determined.  It is not due to exercise, work, or intercourse. The most common cause of a miscarriage is a chromosomal abnormality.  50% of pregnancy losses in the first trimester are due to these chromosomal abnormalities, which form an unhealthy fetus.  Most of these are random events that occur when the egg is fertilized by the sperm and are unlikely to occur in future pregnancies.

The symptoms of a miscarriage are bleeding and pain – it is important to remember that these are symptoms that something may be wrong, but does not mean that the pregnancy will miscarry.  50% of women who have healthy, term pregnancies will experience some pain and bleeding in the first trimester.  If you have pain and bleeding, do not panic.  An evaluation will be necessary to determine if there is a problem.  The evaluation may include blood tests, a pelvic examination, or an ultrasound, depending on how long its been since your last menstrual period.

In the event that testing confirms a problem, the treatment for a miscarriage is frequently a D&C (Dilation and Curettage).  This is a surgical procedure that removes the unhealthy tissue from the uterus.  After a D&C, there may be continued, light bleeding as the lining of the uterus repairs itself and prepares for the next cycle.  Most women will have a normal menstrual period in 4-6 weeks following a D&C.

After a pregnancy loss, many couples need an emotional break to reflect and regroup; many are ready to try again as soon as possible.  These are private and individual decisions and there is no right or wrong approach.  For couples wanting to conceive as soon as possible, waiting until the next normal menstrual period is all that is necessary.