A miscarriage is defined as the spontaneous loss of a pregnancy before week 20. Most miscarriages occur within the first 12 weeks of pregnancy. In Canada, about one in five pregnancies end in miscarriage, most often in the first few weeks of pregnancy. The risk increases with maternal age. As of the age of 40, it is estimated to be 1 in 3 pregnancies. Every year, in Quebec, more than 20,000 pregnant persons have a miscarriage.
Usually, miscarriages cannot be predicted. Most of the time, the causes are unknown, but they can occasionally occur because the fetus has abnormalities and does not develop normally in the uterus. Miscarriages are not caused by stress, fatigue, emotional shock, physical or sexual activity or even by slipping or falling or lifting heavy loads. Some pregnant persons may, however, have risk factors.
Most people know someone who has had a miscarriage. A miscarriage can lead to sadness, distress and even genuine grief for those affected. Having the support of family and friends is important and makes a difference.
Signs and symptoms
The main signs and symptoms of a miscarriage are:
menstrual‑like vaginal bleeding, most often red and sometimes with clots;
pain or cramping in the stomach or lower back;
no longer experiencing the symptoms of pregnancy, such as nausea or swollen breasts.
Some miscarriages can also occur without any symptoms.
About 20‑30% of pregnant persons experience bleeding at least once in early pregnancy. Indeed, the changes caused by pregnancy in the uterus in the first trimester can result in cramping, vaginal discharge or pink or brownish bleeding, with no consequences for the pregnancy. For half of them, however, it will end in miscarriage.
In rare cases, the embryo implants outside the uterus. This is called an ectopic or extrauterine pregnancy. It cannot be brought to term. Prompt management is necessary to initiate medical or surgical treatment. The symptoms of an ectopic pregnancy are similar to those of a miscarriage: abnormal vaginal bleeding and stomach pain (sometimes more on one side than the other) or low back pain.
Risk factors
It is often difficult, if not impossible, to identify the exact cause of a miscarriage. It is most often explained by the fact that the pregnant person’s body recognizes that the fetus is not developing normally.
Factors that can increase the risk include:
being over 35 years of age;
having poorly located uterine fibroids;
having a poorly controlled disease (e.g., diabetes, thyroid problem, hypertension);
have heavy bleeding (more than one sanitary pad per hour);
have severe abdominal pain;
feel dizzy or faint.
If you are worried about your symptoms, consult a health professional. It can be the person who is providing your prenatal care (doctor, midwife or specialized nurse practitioner), your family doctor or the Primary Care Access Point.
If you have any questions and if you would like to be directed to the best resource for your situation, you can also call Info‑Santé 811.
After a miscarriage, it is normal for both parents to experience all kinds of emotions and reactions. People can experience them differently. There are resources that can support you.
Most people who experience a miscarriage will have normal pregnancies afterwards. If you have had several miscarriages, talk to your health care professional.
Assessment and follow‑up of a miscarriage
A miscarriage is confirmed by a physical examination, blood test and ultrasound.
No treatment can stop a miscarriage. Your health professional will tell you what options are available to you.
Depending on your situation, you can choose to:
wait for your body to expel the embryo or fetus naturally;
take a medication that causes contractions and expulsion of the embryo;
have curettage, that is, a surgical procedure that consists of removing, under anesthesia, the embryo and the placenta directly in the uterus.
Pregnant persons whose blood type is Rh‑negative may need to be given preventive medication (WinRho antibodies) if they have bleeding or a miscarriage. Your health professional will discuss this with you.
Grieving pregnancy loss after a miscarriage
It is normal to feel different emotions, such as sadness, anger, guilt or a sense of injustice, and to experience grief.
Reactions may come and go over time. Each person experiences the loss of a pregnancy at their own pace and in their own way. The extent of the emotions is not related to the length of the pregnancy or the circumstances of the loss. Resources are available to support and accompany you and your loved ones.
If they want to, a person can become pregnant again after having a miscarriage when they feel mentally and physically ready.
Help and resources
Several organizations offer information and support services for perinatal bereavement, regardless of when the loss occurred.