Particularly during the first trimester, most moms-to-be are concerned that they might miscarry. How will you know if you're losing the pregnancy? Obstetrical Nurse Wanda F Steele has some information to help you spot
Wanda Steele, RNC

Particularly during the first trimester, most moms-to-be are concerned that they might miscarry. How will you know if you're losing the pregnancy? Obstetrical Nurse Wanda F Steele has some information to help you spot any warning signs.Your question
What are the symptoms of a miscarriage? - Angela in Ohio, Laura in Wisconsin, PB in New York and many others

The expert answers
Hi, Angela -

First, let's do a little defining to be sure that we are all talking about the same thing. What I will be referring to as a "miscarriage" as we get further into this discussion, is the loss of a pregnancy before 20 weeks of gestation. Miscarriages occur in approximately 15-20 percent of all pregnancies, and most occur in the first thirteen weeks (the first trimester). There is a high probability that there are many more miscarriages that are "silent" and go unrecognized, taking place even before a woman is aware that she is pregnant.

The warning signs of a miscarriage are:

  • Spotting or bleeding without pain
  • Heavy or persistent bleeding with abdominal pain or cramping
  • A gush of fluid from your vagina but no pain or bleeding

    Bleeding is the most common sign of a miscarriage but MOST women who have vaginal bleeding or spotting in early pregnancy go on to have healthy babies. Some of these will go on to lose their babies. Bleeding during early pregnancy is called a threatened miscarriage for this reason. This does not mean that the pregnancy will definitely be lost but there is a chance that it might be.

    If you have heavy bleeding and think you may have passed fetal tissue, put it in a clean plastic bag and take it with you to the doctor. The doctor will want to examine you for cervical dilation. If this has occurred, miscarriage is certain.

    If you are past 8 weeks of pregnancy, an ultrasound may be used to see if there is a fetus with a heartbeat inside of the uterus.

    If the doctor does not feel that a miscarriage has taken place then you may be asked to rest and to observe pelvic rest (nothing in the vagina, no sex). These measures have not been proven to prevent miscarriage but they may help reduce bleeding and discomfort.

    If the membranes should rupture during this time of threatened miscarriage then it becomes an inevitable miscarriage because nothing can be done to save the pregnancy at this point.

    Often, when a miscarriage occurs in early pregnancy, there is tissue that is left in the uterus which must be removed to reduce the possibility of infection. This is done with a D&C or dilation and curettage. The cervix is dilated and the inside of the uterus gently scraped to remove any remaining tissue. Sometimes this is done with a vacuum instrument. These procedures are usually done in an outpatient setting or in the emergency room.

    You can expect spotting and some discomfort for a few days. You need to call your doctor is you have heavy bleeding, chills, fever severe pain or foul odor to your discharge.

    For many women, the emotional healing following the loss of a pregnancy can take a lot longer than the physical healing. The thing to remember is that everyone grieves differently. You cannot blame yourself or anyone else for this occurrence. In most cases it is not likely that anything could have been done by anyone to prevent it. If you or your partner and family are having trouble dealing with this loss, talk to your doctor. You may also find that talking with a counselor can be helpful.

    Most miscarriages are due to genetic causes and cannot be prevented. It is often the body's way of dealing with a pregnancy that was not developing normally. This does not mean that anything is wrong with the woman's healthy or that she cannot go on to have more children. Of those women who miscarry, 70-90 percent go on to have a successful pregnancy later.

    Good luck to you,

    Wanda :)

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