Miscarriages - symptoms, causes, diagnosis and treatment
Miscarriage is the spontaneous termination of pregnancy before the 22nd week, affecting up to 50% of all pregnancies. In most cases, it occurs just after the embryo has implanted in the uterus, often without the woman's awareness. As many as 80% miscarriages occur in the first trimester of pregnancy. The main symptoms are severe lower abdominal cramps, bright red bleeding from the genital tract and cessation of pregnancy symptoms. The most common cause is genetic abnormalities of the embryo, especially in older parents. The risk increases from 12-15% in a 20-year-old to over 50% in a 40-year-old. Learn about the detailed symptoms, causes and prevention options.
Highlights
- Miscarriages affect up to 50% of all pregnancies, of which 80% fall in the first trimester.
- Risk of miscarriage increases with age - in a 20-year-old it is 12-15%, in a 40-year-old it exceeds 50%.
- The main symptoms are severe lower abdominal cramps, bright red bleeding from the genital tract and cessation of pregnancy symptoms.
- Over 60% miscarriages results from genetic abnormalities embryo, often related to the age of the parents.
How often do miscarriages occur?
As statistics show, miscarriages end even 50% of all pregnanciesMore than half of these pregnancies are lost shortly after the embryo has implanted in the uterus, with genital bleeding occurring during the perimenopausal period and the woman often not realising that she has just had a miscarriage. Until 80% miscarriages occur in the first trimester of pregnancy (first 12 weeks of pregnancy).
Symptoms of miscarriage
Signs of early miscarriage (up to the 12th week of pregnancy) are:
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relatively strong, long-lasting cramps or pains in the lower abdomen that may radiate to the sacral region;
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bleeding from the genital tract (the blood is bright red in colour and tissue and clots may be visible);
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cessation of symptoms typical of pregnancy (nausea, breast tenderness),
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absence of a fetal pulse on ultrasound (it is detectable from the fifth week of pregnancy).
In the 14th week of pregnancy, the placenta is fully formed - the termination of pregnancy from this point onwards is known as a late miscarriage . It manifests itself in a similar way to an early miscarriage, but the severity of the symptoms (genital bleeding, cramps) is much greater.
During miscarriages late amniotic fluid drains away, and if infection of the amniotic egg is present, the woman may experience high fever and chills, muscle pains
Asymptomatic miscarriage
A miscarriage can also occur asymptomatically, as the fetus dies in the uterus. In this case, there is a so-called "retained miscarriage", which can only be detected by ultrasound examination. Sometimes, a poor prognosis for the development of the pregnancy is established during an ultrasound examination carried out at an early stage - worrying signs include delayed embryo development in relation to the age of the pregnancy and a very slow heart rate in the foetus.
Genital tract bleeding in pregnancy - what to do?
Not all genital bleeding ends in miscarriage, but the occurrence of this symptom should prompt the pregnant woman to consult an obstetrician-gynaecologist as soon as possible (in the ED or on-call gynaecology department at the hospital, especially if the bleeding is heavy).
Miscarriage - medical intervention
In some patients, it is possible to stop a miscarriage by promptly instituting pharmacological treatment, but in most cases the use of pregnancy support measures has no effect, as miscarriage is de facto a natural mechanism available to the mother's body to eliminate an embryo that is not developing properly.
Medical assistance for miscarriage also includes performing a curettage of the uterine cavity if the organ has not completely cleared following the loss of the pregnancy, and in cases of persistent heavy bleeding from the genital tract.
Causes of miscarriage
Miscarriages in the first trimester of pregnancy are most commonly due to genetic factors (genetic disorders in the foetus), abnormalities in the structure of the uterus and abnormalities in the formation of the foetal egg and surrounding tissues (trophoblast).
In the later stages of pregnancy, miscarriage is sometimes the result:
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hormonal disorders (insufficient progesterone production by the placenta or corpus luteum);
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systemic diseases in the pregnant woman (hypothyroidism, uncompensated diabetes);
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autoimmune factors (e.g. antiphospholipid syndrome);
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severe bacterial or viral infections in a woman, which led to infection of the foetal egg;
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cervical insufficiency (spontaneous cervical dilation).
Miscarriages and the age of women and men
An important factor influencing the risk of miscarriages is the age, both of the woman and her partner.Â
Research after miscarriage
After a first miscarriage, doctors usually order basic investigations, assuming that the pregnancy loss may have been a random event. Above all, it is necessary to rule out the role of systemic diseases and to assess whether the pregnant woman's lifestyle had an impact on the miscarriage.
If there have been more miscarriages, it is worth implementing a full diagnostic workup, with a view to:
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exclusion of genetic disorders (survey karyotypes in both partners);
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detect possible anatomical abnormalities in the structure of the uterine cavity (hysteroscopy);
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exclusion of blood coagulation disorders, especially hypercoagulability (e.g. antiphospholipid syndrome);
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determine whether the miscarriages may have been related to the existence of infectious agents (e.g. chlamydial infection);
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evaluation of the endocrine profile and exclusion of the role of disorders endocrinology in pregnancy loss.
Depending on the history taken, diagnosed disorders and past medical history, the doctor may also order other tests.
Habitual miscarriages
Full diagnostics are essential in the case of a miscarriage of the third consecutive pregnancy (known as a 'third pregnancy'). habitual miscarriages), as each subsequent pregnancy will automatically be treated as a high-risk pregnancy, requiring surveillance and treatment (if the cause of the miscarriages can be established in time, there is a chance of causal treatment).Â
It is advisable to have diagnostic tests carried out at an infertility clinic, as such centres provide access to full diagnostics and rapidly implemented treatment - and time is at a premium, especially in the first trimester of pregnancy when the risk of miscarriage is greatest.
In the case of recurrent miscarriages or repeated embryo implantation failures, diagnostics for the cause may also be considered immunological.
Find out more about consulting an immunologist >>
Miscarriage after in vitro
Before an IVF approach, a woman is examined in detailsystemic diseases, anatomical defects and infections are excluded, and after the embryo is transferred into the uterine cavity, the patient takes pharmacological agents (mainly the hormone progesterone and its derivatives) to prevent hormonal deficiencies and increase the chances of successful embryo implantation. In addition, she is advised to rest, avoid intercourse, stress and prolonged shock.
Despite this, approximately 16% cases result in early pregnancy loss. Miscarriages are more common in older patients, so it can be assumed that they are most often caused by abnormalities in the genetic material of the embryo.
In this situation, if the couple still has frozen embryos, doctors generally modify the pharmacotherapy before the next approach to the in vitro. Often, additional tests are performed and their selection is individual, depending on the couple's situation.Â
Miscarriage after in vitro a genetic factors
Doctors may also opt to use the so-called 'medicalisation'. preimplantation screening (PGT-A), a study of the genetic status of embryos before they are implanted in the uterine cavity.
If miscarriages are found to occur because one or both parents carry a genetic defect, which significantly reduces the chances of giving birth to a healthy baby (or makes it impossible to carry a pregnancy), parents can use cells from an anonymous donor or donor.
Find out more about oocyte adoption programmes at Invimed >>.
Prevention of miscarriages
Miscarriage prevention includes lifestyle modification (balanced diet, avoidance of stimulants, sleep hygiene, moderate physical activity, skilful stress management), appropriate treatment of systemic diseases and infections, and removal of diagnosed causes of miscarriage (e.g. surgical correction of anatomical abnormalities of the uterus).
It is a good idea to test levels early in pregnancy:
- progesterone (Deficiency of this hormone due to failure of the gestational corpus luteum can result in bleeding, cramps and miscarriage);
- estrogens ovarian;
- pregnancy hormone hCG (the result of the test helps to determine whether the pregnancy is developing normally).
The results obtained should always be analysed based on the treatment given and the clinical condition of the pregnant woman.
Pregnancy after miscarriage
The good news for women who have experienced a pregnancy loss is that it is possible to get pregnant again after a miscarriage, and the chances of carrying the pregnancy to term are higher than with a first pregnancy. If you have experienced a miscarriage, consult an infertility clinic.
If you have experienced miscarriages, consult an infertility clinic.
To arrange a consultation or teleportation at Invimed, call:Â 500 900 888.
Yes, the possibility of having children after multiple miscarriages exists. After appropriate diagnosis and identification of the cause of pregnancy loss, causal treatment can be implemented.
It is most often recommended to wait 2-3 months before trying again for pregnancy. This time allows the body to recover hormonally and mentally. In the case of late miscarriages or complications, it may be necessary to wait longer - the decision is made by the attending doctor.
Severe, chronic stress can affect the course of pregnancy through hormonal disturbances and weakened immunity. However, it is not a direct cause of miscarriages - most cases are due to genetic abnormalities of the foetus. However, it is worth taking care of mental balance during pregnancy.
After one miscarriage, basic investigations are usually sufficient: morphology, thyroid hormone levels and gynaecological ultrasound. After two or more miscarriages, genetic testing of the partners, assessment of blood clotting, hysteroscopy and detailed hormonal and immunological diagnosis are necessary.
Not every miscarriage requires a curettage. The procedure is only performed if the uterus has not cleared on its own or heavy bleeding persists. In many cases, the body copes naturally and the doctor monitors the process with ultrasound examinations and monitoring of hCG levels.
- Laudanski, P. (2021). Miscarriage. In G. H. Bręborowicz, K. Czajkowski, T. Rechberger (Ed.), Położnictwo i ginekologia Volume 1-2 (pp. 81-88). Warsaw: PZWL Wydawnictwo Lekarskie.
2nd Practical Medicine. (2024). Miscarriage. Retrieved from https://www.mp.pl/pacjent/ciaza/przebiegciazy/90964,poronienie
The medical information presented should be considered as general guidelines and does not replace the individual judgement of the doctor regarding the medical management of each patient. The doctor, after a thorough examination of the patient's condition, determines the extent and frequency of diagnostic tests and/or therapeutic procedures, taking into account specific medical indications. All medical decisions are made in full consultation with the patient.
Author of the article
Invimed editorial team - we serve patients by solving their fertility problems. We use world medical knowledge, state-of-the-art technology and treatment methods. We are here to make dreams of parenthood come true. The smiles on the faces of happy parents give meaning to our work.
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