A miscarriage, also called spontaneous abortion, is the spontaneous ending of a pregnancy before the fetus is mature enough to survive outside the uterus. About one-third of all pregnancies end in miscarriage, most often before a woman misses a menstrual period or even knows she is pregnant. A miscarriage is most likely to occur within the first three months of pregnancy, before 20 weeks gestation. Only 1 percent of miscarriages occur after 20 weeks gestation. These are termed late miscarriages.

What are the symptoms of a miscarriage?
Symptoms of a miscarriage include:

• Bleeding that progresses from light to heavy
• Cramps
• Abdominal pain
• Fever
• Weakness
• Vomiting
• Back pain

What causes miscarriage?
About half of all miscarriages that occur in the first trimester are caused by chromosomal abnormalities — which might be hereditary or spontaneous — in the father’s sperm or the mother’s egg. Chromosomes are tiny structures inside the cells of the body that carry many genes, the basic units of heredity. Miscarriages are also caused by a variety of unknown and known factors, such as:

• Infection
• Exposure to environmental and workplace hazards such as high levels of radiation or toxic agents
• Hormonal irregularities
• Uterine abnormalities
• Incompetent cervix (The cervix begins to widen and open too early, in the middle of pregnancy, without signs of pain or labor.)
• Lifestyle factors such as smoking, drinking alcohol, or using illegal drugs
  Disorders of the immune system including lupus, an autoimmune disease
• Severe kidney disease
• Congenital heart disease
• Diabetes that is not controlled
• Thyroid disease
• Radiation
• Certain medicines, such as the acne drug Accutane
• Severe malnutrition
• Group B beta strep

What are the risk factors for a miscarriage?
A risk factor is a trait or behavior that increases a person’s chance of developing a disease or predisposes a person to a certain condition. Risk factors for miscarriage include:

Maternal age — Studies show that the risk of miscarriage is 12 percent to 15 percent for women in their 20s and rises to about 25 percent for women at age 40. The increased incidence of chromosomal abnormalities contributes to the age-related risk of miscarriage.
Certain health conditions in the mother as listed above in the section, "What causes miscarriage?"
How is a miscarriage diagnosed and treated?
Your health care provider will perform a pelvic exam and an ultrasound test to confirm the miscarriage. If the miscarriage is complete and the uterus is clear, then no further treatment is usually required.

If a miscarriage was not confirmed, but you had symptoms of a miscarriage, bed rest is often prescribed for several days, and you might be admitted to the hospital overnight for observation. When the bleeding stops, usually you will be able to continue with your normal activities.

Blood tests, genetic tests, or medicine might be necessary if a woman has more than two miscarriages in a row (called repeated miscarriage).

Most women (87 percent) who have miscarriages have subsequent normal pregnancies and births. Having a miscarriage does not necessarily mean you have a fertility problem. About 1 percent of women might have repeated miscarriages (three or more). Some researchers believe this is related to an autoimmune response.

Discuss the timing of your next pregnancy with your health care provider.

Some health care providers recommend waiting a certain amount of time (from one menstrual cycle to three months) before trying to conceive again. To prevent another miscarriage, your health care provider might recommend treatment with progesterone, a hormone needed for implantation in the uterus.

Taking time to heal both physically and emotionally after a miscarriage is important. Above all, don’t blame yourself for the miscarriage.

If you’ve had two miscarriages in a row, you should stop trying to conceive, use a form of birth control, and ask your health care provider to perform diagnostic tests to determine the cause of the miscarriages.

Can a miscarriage be prevented?
Usually a miscarriage cannot be prevented and often occurs because the pregnancy is not normal.

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