Early pregnancy loss: Your questions answered

Questions about early pregnancy loss (miscarriage) answered by Dr. Leslie Po, obstetrician & gynecologist at Sunnybrook.

“What now?” This is one of the most common questions from women who have experienced an early pregnancy loss. Women understandably have a lot of questions following a pregnancy loss, including ‘What just happened to me?’, ‘Why didn’t my pregnancy continue?’ and of course ‘What happens now?'

Early pregnancy loss is also called miscarriage. You may hear your health-care team refer to it as spontaneous abortion. It is the loss of a pregnancy in the first 13 weeks of pregnancy. And it’s common: early loss occurs in 20 to 25 per cent of pregnancies.

Different kinds of early pregnancy loss

  • Complete miscarriage means you have passed all of the pregnancy tissue. Your uterus or womb is empty and you don’t need any additional treatment.
  • Incomplete miscarriage means you have passed some of the pregnancy tissue, but there is still some left in the uterus or womb.
  • Missed abortion means the pregnancy has stopped developing but your body has not started to pass the tissue yet.

If you have an incomplete or a missed abortion, you may need additional treatment.

What are my treatment options?

For an incomplete or missed abortion, you can “wait and see”, take medication or have surgery. Your doctor should help you decide which treatment is best for you.

  • Wait and See: Some women tell me they don’t want to take medication or have surgery, and wonder what to expect if they decide to “wait and see”. It can take up to four weeks for the pregnancy tissue to pass on its own. When it does pass, you’ll have cramping and bleeding, similar to a heavy period. It’s hard to predict when this will happen. You may pass tissue that looks like a liver (the organ), or you may pass blood clots. If you’re bleeding heavily enough to soak more than a pad an hour, or if you have a fever, severe pain or feel unwell, you need to go to the closest Emergency Department right away. These symptoms may be signs you’re losing too much blood or have an infection. It can take up to two weeks for all of the tissue to pass and you may have bleeding for this entire time. Sometimes a small amount of tissue is left behind and you may need surgery or medication to completely clear out your uterus. If your bleeding lasts longer than two weeks, see your doctor.
  • Medication: You’ll be given a prescription for a medication called misoprostol. Push these tablets with your finger into the vagina as far as you can. This medication will cause your uterus to contract and push out the pregnancy tissue. Cramping and bleeding usually start within 6-8 hours after taking the medication. You may experience side effects such as diarrhea, low-grade fever (less than 38.2 Celsius) and nausea. If you’re bleeding heavily enough to soak more than a pad an hour or have a fever greater than 38.2 Celsius, severe pain or feel unwell, you need to go to the Emergency Department right away. Much like the wait and see approach, it can take up to two weeks for all of the tissue to pass and you may have bleeding for this entire time. Sometimes a small amount of tissue is left behind and you may need surgery or more medication to completely clear out the uterus. If your bleeding lasts longer than two weeks, see your doctor.
  • Surgery: The procedure to clean out your uterus is called dilatation and curettage or “D&C”. A D&C is a surgery that can be done in an operating room while you are completely asleep but can it also be done awake in an outpatient clinic. Once you are comfortable, your doctor will use instruments to dilate your cervix and remove your pregnancy tissue. There are some risks, as with any surgery, and they include: excessive bleeding, infections, injury to the cervix caused by instruments, injury to the uterus caused by instruments and possibly the need to do another surgery to check other organs in the abdomen and scarring of the lining of the uterus, which can make getting pregnant in the future more difficult.

The good news: your chance of a normal pregnancy next time is the same with all three options.

Why did this happen?

The most important thing is for you to know that you did not do anything to cause the miscarriage to happen. The truth is that most miscarriages happen because of genetic problems in the pregnancy.

When there is a genetic problem, a baby cannot develop and the pregnancy stops growing. I have had women ask me, “I’ve still been doing my usual workout at the gym…could that have caused the miscarriage?” Absolutely not. And other normal daily activities like sex or falling down or working don’t cause miscarriage. Drinking three cups of coffee or less every day doesn’t increase the risk of miscarriage.

It’s not clear if drinking alcohol increases the chance of miscarriage. We do know some research shows smoking may increase the chance of having a miscarriage.

What now?

Your doctor will want to make sure all of the pregnancy tissue is cleared out of your uterus. If any tissue is left behind, it can cause heavy bleeding or an infection. You may need an ultrasound to see how much pregnancy tissue is still inside your uterus. As well, your doctor may order a blood test to check your pregnancy hormone, or beta-HCG level. If this hormone is high, it’s likely there is still pregnancy tissue left in your uterus.

My doctor said she needs to check my blood type…why?

It’s really important to check your blood type to see if you are Rh-positive or Rh-negative. Most people have Rh-positive blood. Rh is a protein that can be found on red blood cells. If you’re Rh-positive, your blood cells have this protein. Whether or not you’re Rh-positive or Rh-negative is determined by your genetics; and because babies have genes from their mother and father, the baby might have a different blood type than the mother.

If you’re Rh-positive, you don’t need any treatment. If you’re Rh-negative, it’s important you get a shot called “RhoGam” or “WinRho” as soon as possible. In case your baby has Rh-positive blood, this shot will prevent your body from developing antibodies to your baby’s blood, which can lead to serious complications for any new pregnancies.

The big question: can I get pregnant again?

Yes, absolutely! Early pregnancy loss is usually a chance, one-time event. Most women go on to have successful, healthy pregnancies next time. A single miscarriage does not increase your chances of having another miscarriage in the future. However, if you do have more than three miscarriages, your doctor may decide to do some testing to look for a possible cause.

How long do I need to wait before trying to get pregnant again?

It usually takes between four to six weeks to get your period after a miscarriage. If you want to get pregnant as soon as possible, you can start as soon as you get your period. Waiting until your first period helps to ensure the miscarriage is complete and also helps your doctor date your next pregnancy. If you don’t want to get pregnant, talk to your doctor about a birth control method that’s right for you.

I’m really sad and upset. Is this normal?

Absolutely. The loss of any pregnancy, at any time, can be very upsetting. A range of emotions are normal after miscarriage. These can include sadness, grief, self-doubt or guilt, shock and denial. Women and their partners and families can react differently to the news of a pregnancy loss. For some people, this can last a very long time and be very upsetting.

Where can I get help, support and more information?

If you’re having difficulty coping or feel you would like some support, contact your family doctor. There are also many organizations that you can contact to get more help, support and information:

  • Pregnancy and Infant Loss Network (PAIL Network) and 416-480-5330 or 1-844-772-9388
  • Bereaved Families of Ontario: and 416-440-0290 or 1-800-236-6364