Miscarriage

Miscarriage is the loss of a pregnancy before 24 weeks of gestation, most commonly occurring in the first trimester. It is common and, in most cases, is not caused by anything the woman did or could have prevented.

• Vaginal bleeding, which can range from light spotting to heavier bleeding
• Cramping or abdominal pain, similar to or more intense than period pain
• Passage of tissue or clots from the vagina
• Loss of previously experienced pregnancy symptoms, such as breast tenderness or nausea, though this alone is not a reliable sign

• Most first-trimester miscarriages result from a chromosomal abnormality in the developing pregnancy, unrelated to anything the mother did.
• Risk is increased by increasing maternal age, certain chronic medical conditions, some infections, and, for recurrent miscarriage, some specific underlying causes that can be investigated.
• In many individual cases, a specific cause is never identified.

• Suspected based on vaginal bleeding and/or cramping in early pregnancy.
• Pelvic ultrasound is used to assess the pregnancy and determine whether it is ongoing, has been lost, or whether the diagnosis is still uncertain and needs repeat assessment.
• Blood tests measuring the pregnancy hormone (beta-hCG) over time can help clarify the diagnosis in some situations, particularly when ultrasound findings are not yet clear.

Management depends on the stage and type of miscarriage, and options generally include watchful waiting to allow the process to complete naturally, medicine to help complete the process, or a minor procedure to remove remaining pregnancy tissue — the choice is guided by the woman's clinical situation and preference.

Heavy bleeding, signs of infection, or significant pain require prompt medical assessment, as these may need more urgent management.

Rh-negative women require an injection to prevent complications in future pregnancies, following local protocol.

Emotional support is an important part of care, as miscarriage can be a significant source of grief, and women and their partners should be offered the opportunity to discuss their experience and ask questions about future pregnancies.

• Attend early antenatal care, which supports monitoring of pregnancy health, though it cannot prevent most miscarriages since these are typically related to chromosomal factors beyond anyone's control.
• Manage chronic health conditions well before and during pregnancy.
• Avoid smoking, alcohol, and other known harmful exposures during pregnancy.
• Seek prompt medical care for bleeding or pain in pregnancy, and seek support — including from a health worker — to process the emotional impact of a pregnancy loss.