For many parents, after the initial elation of a positive pregnancy test begins to fade, a sense of fear may start to settle in. It’s not the idea of parenthood that has us so scared, but the thought of pregnancy loss. With an estimated 26% of all pregnancies ending in miscarriage, this unease is understandable.
Pregnancy can come with many symptoms, and you may assume the worst with every new ache or pain you experience when you’re expecting—especially if you’re unsure how to identify the signs of a miscarriage. Even if you know the symptoms of pregnancy loss, you might feel anxious as you wonder about the following steps if you should find yourself in this position.
To help provide a clear understanding of what to do in the event of a miscarriage, we reached out to experts Jian Jenny Tang, MD, an assistant professor of obstetrics, gynecology, and reproductive science at the Icahn School of Medicine at Mount Sinai in New York, and Steffanie Wright, MD, MPH, MS, an OB-GYN at Weill Cornell Medicine in New York. Together, they share insight into pregnancy loss symptoms, treatment, pain management, and more.
When Can Miscarriages Happen?
According to Dr. Wright, “[Miscarriages] can occur at any time in pregnancy but are most common during the first trimester.” In fact, it’s estimated that around 80% of all pregnancy losses happen in the first 12 weeks.
Dr. Tang notes that miscarriages can occur at any point during the first 20 weeks of pregnancy (a loss after 20 weeks is considered a stillbirth). However, they typically occur during the first six to eight weeks of pregnancy.
Dr. Tang says, “The most common cause for pregnancy loss is abnormal chromosome, also known as aneuploidy of the fetus,” which can be either the presence or absence of one or more chromones.
Common Miscarriage Symptoms and What to Do If You Experience Them
“The most common [pregnancy loss] symptoms are cramping and bleeding,” says Dr. Wright, “but this can vary from person to person.” In terms of how much blood signals a miscarriage, the American College of Obstetricians and Gynecologists (ACOG) notes that “a small amount of bleeding in early pregnancy is common and does not necessarily mean that you will have a miscarriage.”.
In addition to cramping and bleeding, Dr. Tang says “loss or reduction of pregnancy symptoms, such as nausea, vomiting, breast tenderness, or tiredness” can also be signs of miscarriage. Finally, Dr. Wright says in some cases, “Patients may not experience any symptoms and then find out they experienced a miscarriage at their prenatal appointment.”
Dr. Tang and Dr. Wright stress that if you experience any bleeding or any other possible symptom of a miscarriage at any point during pregnancy, it’s vital to reach out to your health care provider to determine the next steps. “ Medical advice doesn’t change based on the gestational age,” notes Dr. Tang.
When to Seek Emergency Care
In some cases, severe symptoms may prompt your OB-GYN to direct you to head to the nearest emergency department, including heavy vaginal bleeding or signs of infection, according to Dr. Tang. “Heavy vaginal bleeding usually means that you are either passing golf ball-sized blood clots or soaking through maximum sanitary pads every hour for two to three hours,” she explains. Signs of infection can include “fever, severe lower abdominal pain, foul-smelling vaginal discharge, low pressure, feeling faint, or lightheadedness.”
Dr. Wright adds that miscarriage symptoms in the second or third trimesters typically call for emergency care (more on this later) and that you should proceed to the nearest emergency room if you are experiencing “severe pain.”
Miscarriage Treatment and Interventions
How a miscarriage is treated or managed depends on factors such as how far along an expecting parent is, the severity of symptoms, and how the body handles the situation on its own. The first step is typically a sonogram to “confirm the diagnosis,” says Dr. Tang. Once your provider has verified that you are experiencing pregnancy loss, Dr. Wright says, “The three most common management paths include expectant management (watchful waiting), medical management with a combination of medications, or surgical management.”
Typically, Dr. Tang explains, “If the patient prefers a less invasive or more natural [treatment] approach, expectant management is safe for patients with miscarriage under six weeks [gestation], with timely follow-up.” However, this approach is not recommended for loss after 12 weeks of pregnancy, as it will “increase risks of bleeding and infection; therefore, surgical approach is better.” Finally, she says, medication management is “highly effective for miscarriages under eight weeks.”
In the case of medication management, Dr. Tang says your provider will have you take two different medications over 24 to 48 hours to help the body completely expel the remaining tissue. This regimen includes the drugs mifepristone and misoprostol. It’s important to note that though, in this case, these medications would be used to treat a miscarriage, due to the Supreme Court overturning Roe v. Wade in 2022, whether or not you have access to these medications during a miscarriage depends on abortion laws in the state where you’re seeking treatment.
Surgical management of pregnancy loss helps to ensure no remaining tissue in the body after the miscarriage. According to Dr. Wright, patients undergoing this treatment will likely have a dilation and curettage (D&C) if the loss occurs in the first trimester or a dilation and evacuation (D&E) if the loss happens in the second or third trimester.
There are two parts to miscarriage recovery: physical and emotional.
In terms of physical recovery, Dr. Wright generally recommends patients take Ibuprofen or Tylenol. , warm compresses, and rest. Dr. Tang notes that these medications can help patients manage common side effects, including nausea and vomiting.
The emotional pain often outlasts the physical, with parents experiencing a wide range of feelings, including depression, anxiety, and even post-traumatic stress disorder (PTSD), according to Dr. Tang. “We teach patients coping methods like meditation, breathing, and journaling” to help them process their feelings. Additionally, Dr. Tang and Dr. Wright emphasize the importance of support and community during this time. “After a miscarriage, I always encourage patients to lean on their friends and family,” says Dr. Wright, adding, “Miscarriage is unfortunately very common, and you may be surprised to find a friend or family member has gone through a similar experience.”
There is no timetable for emotional recovery after pregnancy loss—you may be ready to try to get pregnant again right away, or you may need a few months (or longer). However long it takes, if you decide to try to conceive after a miscarriage, Dr. Tang and Dr. Wright emphasize that most patients who experience pregnancy loss go on to have successful subsequent pregnancies.