Miscarriage Heather Welford Miscarriage is the spontaneous loss of a pregnancy before 24 weeks. In most cases it can't be predicted or avoided.

In this article

How common is it? What causes it? Who's affected?

What are the symptoms? What you should do?

Recovering afterwards Future pregnancies

The charity Tommy's estimates one in four women experiences miscarriage at some point, and one in five pregnancies ends in this way.

The most common time for a miscarriage is in the first 13 weeks. This is termed an 'early' miscarriage.

Most miscarriages are the result of a genetic abnormality in the embryo or foetus.

Half of all early miscarriages are caused by a chance abnormality that's unlikely to happen again. Some genetic abnormalities, however, are inherited. If you have repeated miscarriages, this would be investigated as a possible cause.

Other less common causes of miscarriage include:

• Abnormal hormone levels - can affect the body's ability to nurture a pregnancy
• Problems with the cervix - if it opens too soon it can lead to late miscarriage
• Problems with the uterus - it may be unusually shaped, divided in two by a thin membrane or there may be fibroids, all of which can restrict space for the foetus
• Blood clotting disorders - blood flow affects the way early pregnancy is nourished and, later, how the placenta safeguards the foetus
• Infection - blood infections and food poisoning, such as listeria, can (very rarely) lead to miscarriage

Other problems that can lead to the end of the pregnancy include:

• Blighted ovum - pregnancy hormones make your periods stop because an egg is fertilised and a sac develops, but the fertilised egg doesn't grow any further (also known as 'anembryionic pregnancy' or pregnancy without an embryo).

• Hydatidiform mole/molar pregnancy - the trophoblast (which would become the placenta) becomes a mass of fluid-filled cells. There may be no embryo, or only the early signs of one. This is very unusual and requires careful monitoring as rarely a molar pregnancy can lead to a cancerous tumour.

• Ectopic pregnancy - the foetus starts to develop outside the womb, usually in one of the fallopian tubes. Symptoms include pain, fatigue and possibly bleeding. Surgery is required to end the pregnancy and prevent further complications.

Although the reason for most early miscarriages isn't understood, you're at higher risk if you're older, have had fertility problems or previous miscarriages, if you're significantly underweight or overweight, if your partner's older, or if you drink alcohol regularly or in large amounts.

Working during pregnancy isn't relevant. A healthy diet appears to lower risk.

A women experiencing a miscarriage may have any or all of the following symptoms:

• Pain, caused by the contractions of the uterus
• Bleeding from the vagina
• Leaking of amniotic fluid (only happens in later miscarriages)

When the miscarriage takes place, the foetus is lost through the vagina, along with the placenta and membranes.

Occasionally, a 'missed' or 'delayed' miscarriage occurs. This is when the foetus dies but doesn't leave the womb. This may only show up during a routine scan.

If you suspect you're about to have a miscarriage, speak to your doctor or midwife as soon as possible.

If you do miscarry, or know for certain a miscarriage is occurring, you may need to go into hospital to ensure all the pregnancy has come away. This is called 'evacuation of retained products of conception' and is done under general anaesthetic.

With a late miscarriage, you may be given medication to start labour or you can discuss letting nature take its course without inducing labour.

Physical recovery can take a few days. You'll probably start your periods again after four to six weeks.

Your emotional response will be individual to you and you may have a range of feelings. Fathers also grieve after pregnancy loss and may need space for their own feelings.

In most cases, there's no physical reason for waiting before conceiving again, but talk to your GP and your partner. You may need time and space to come to terms with the emotional effects of the miscarriage.

If the miscarriage was caused by hormonal or blood-clotting problems, you may be given medication to help prevent this happening again. If there was a problem with the cervix opening too soon, a stitch ('cervical cerclage') may be put in place to keep it closed.

If the miscarriage appears to have happened by chance - even if you've had two - your GP may just reassure you and tell you to try again.

If it looks like there may be an identifiable cause, or you've had more than two or three miscarriages, you may be referred for investigations.

Statistics show that even after three or four miscarriages the chances of a successful pregnancy are still higher than a further miscarriage.

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