Miscarriage: understanding early pregnancy loss
A miscarriage is the loss of a pregnancy before 24 weeks. It is more common than many people realise, and the grief and confusion that can follow are completely valid responses. This article, based on NHS guidance, explains what miscarriage is, why it happens, what signs to look for, what treatment options are available, and where to find support.
How common is miscarriage?
Around 1 in 8 known pregnancies end in miscarriage, according to the NHS. The actual rate is likely higher, because a significant number of miscarriages happen so early that the pregnancy was never confirmed. The vast majority of miscarriages occur in the first 12 weeks of pregnancy, and while that knowledge does not make the loss any less painful, it can help to understand that this is a relatively frequent medical event, not something unusual or caused by anything you have done.
Why does miscarriage happen?
The most common cause of miscarriage, particularly in the early weeks, is a chromosomal abnormality in the developing embryo. When chromosomes do not form or divide as they should, the pregnancy is unable to develop normally, and the body ends it. This is a biological process, not a reflection of your health, your actions or your suitability for parenthood. Miscarriage is not caused by exercise, sex, work, stress or anything else you may have done during early pregnancy.
Less commonly, miscarriage can be linked to other factors, such as a structural problem with the uterus or a weakness in the cervix. These causes are rarer and are more likely to be explored if you experience recurrent pregnancy loss.
Signs and symptoms of miscarriage
The most common signs of miscarriage are vaginal bleeding and cramping or pain in the lower abdomen. Some people also notice that symptoms of early pregnancy, such as nausea or breast tenderness, begin to fade. It is important to know, however, that bleeding and cramping can happen in early pregnancy without a miscarriage occurring, and that some miscarriages produce no symptoms at all and are only discovered at a routine scan. If you have any bleeding or pain during early pregnancy, the right step is to contact your GP, midwife or Early Pregnancy Unit for assessment rather than trying to interpret the signs yourself.
Types of miscarriage
Healthcare professionals use several terms to describe different stages or presentations of pregnancy loss, and you may hear these when you are assessed:
- Threatened miscarriage: bleeding occurs but an ultrasound confirms the pregnancy is still continuing. The outcome remains uncertain.
- Inevitable miscarriage: bleeding and cervical changes indicate the pregnancy will not continue.
- Incomplete miscarriage: the pregnancy has ended but some pregnancy tissue remains in the uterus.
- Complete miscarriage: all pregnancy tissue has passed naturally from the uterus.
- Missed miscarriage: the pregnancy has ended but the body has not yet recognised this, so there may be no bleeding or pain. This is often discovered during a routine scan.
Knowing which type applies to your situation helps your care team explain what is likely to happen next and which treatment options are appropriate for you.
What to do if you think you are having a miscarriage
If you have bleeding or cramping in early pregnancy, contact your GP, midwife or the Early Pregnancy Unit (EPU) at your local hospital. An EPU is a specialist service that can arrange an ultrasound scan to find out what is happening and talk you through your options. You do not need to wait and see: reaching out early means you get the care and information you need sooner. If the bleeding is very heavy, if you are passing large clots, or if the pain is severe, go to the emergency department or call 999.
Treatment options
When a miscarriage is confirmed, your care team will explain the options available to you. There is rarely a single right answer, and the choice often depends on your personal circumstances, how far along the pregnancy was, and whether there is any remaining tissue in the uterus.
- Expectant management: waiting for the pregnancy tissue to pass naturally, without any intervention. This can take a few weeks.
- Medical management: medication is used to help the body complete the process. This is usually an option when the process is not completing naturally or when a missed miscarriage has been identified.
- Surgical management: a procedure under anaesthetic to remove any remaining pregnancy tissue from the uterus. This may be recommended in certain circumstances or offered as a choice to those who prefer a quicker resolution.
All three approaches are considered safe by the NHS. Your care team will help you weigh up what feels right for you, and you can ask questions about any aspect of these options before making a decision.
Recurrent miscarriage
Recurrent miscarriage is generally defined as three or more miscarriages in a row. This affects a small number of people and, while it can be devastating, it does not mean a successful pregnancy is impossible. The NHS recommends referral to a specialist for investigation if you have experienced three or more consecutive losses. Tests can explore a range of possible causes, including chromosomal factors in either partner, structural issues in the uterus, blood clotting disorders, and other conditions. In some cases, no cause is found, but many people with recurrent miscarriage do go on to have a healthy pregnancy.
The emotional impact of pregnancy loss
Miscarriage is a bereavement, and the feelings that follow can be just as intense as any other form of grief. Sadness, anger, guilt, and anxiety about future pregnancies are all completely normal responses. Some people feel a sense of failure or wonder whether they did something wrong; it is important to remember that miscarriage is almost never caused by anything the person carrying the pregnancy did or did not do.
Partners can grieve too, and couples sometimes find that they process the loss in different ways and at different times. There is no timeline for recovering from pregnancy loss, and there is no correct way to feel. If grief is feeling overwhelming, or if anxiety about a future pregnancy is significant, your GP or midwife can refer you to counselling or a specialist perinatal mental health team. Charities including the Miscarriage Association and Tommy's also offer helplines and peer support specifically for those who have experienced pregnancy loss.
Frequently asked questions
How common is miscarriage?
Around 1 in 8 known pregnancies end in miscarriage. The true rate is higher, as many miscarriages happen before a pregnancy is recognised. The large majority occur in the first 12 weeks.
What causes a miscarriage?
Most early miscarriages are caused by a chromosomal abnormality in the developing embryo, which means the pregnancy would not have been able to develop normally. This is not caused by anything you did or did not do. Other causes are less common and include problems with the uterus or cervix.
What should I do if I think I am having a miscarriage?
Contact your GP, midwife or the Early Pregnancy Unit (EPU) at your local hospital. They can confirm what is happening with an ultrasound scan, offer support and explain your options. If you have very heavy bleeding or severe pain, go to the emergency department or call 999.
What support is available after a miscarriage?
The Miscarriage Association and Tommy's both offer information, helplines and peer support for people who have experienced pregnancy loss. Your GP and midwife can also refer you to counselling or a specialist perinatal mental health team if you are struggling emotionally after a loss.
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