Miscarriage Comes in Many Forms

No matter how far into a pregnancy, a miscarriage can be a traumatic, difficult time for parents-to-be. There are several types of miscarriages that can occur at different stages in the pregnancy.

It's important that you look out for any subtle changes in the body, as a miscarriage doesn't always present with noticeable symptoms. Here's what you need to know.

The types of miscarriage

Miscarriage is defined as the spontaneous loss of pregnancy before the 20th week. While that definition encompasses all early pregnancy loss, the term "miscarriage" can be used in various ways.

• Chemical miscarriage occurs very early in pregnancy when the egg is fertilized but doesn't implant in the uterus.
• Threatened miscarriage does not actually indicate pregnancy loss but instead is a term used to describe abnormal bleeding and pain while the pregnancy continues. Any vaginal bleeding after the first trimester can be considered a threatened miscarriage.
• Incomplete miscarriage occurs when the pregnancy tissue does not fully leave the uterus. While most miscarriages will pass on their own, sometimes a dilation and curettage (D&C) will need to be performed in order to remove the remaining tissue.
• Missed miscarriage is when the baby passes away but remains in the uterus.
• Inevitable miscarriage can occur after a threatened miscarriage or with no warning. In this case, the developing fetus will shed with vaginal bleeding.
• Recurring miscarriage is rare and defined as three or more consecutive pregnancy losses.

Less recognized forms of miscarriage include ectopic pregnancy and molar pregnancy.

Why and when do miscarriages occur?

Chemical pregnancies are very common, with one-third of pregnancies resulting in an early miscarriage at five weeks or before. In many cases, the pregnancy goes undetected, with some women believing they are experiencing a normal period. Some women may notice heavier bleeding, blood clots and an increase in abdominal cramping.

"The most common type of miscarriage happens in the first trimester, or the first 12 weeks of pregnancy. These losses represent about 80 percent of all miscarriages," said Kate White, M.D., M.P.H., an associate professor of obstetrics and gynecology at the Boston University School of Medicine and author of "Your Guide to Miscarriage & Pregnancy Loss."

An early miscarriage can be very distressing, especially if it occurs shortly after a positive test result. However, in most cases, there's very little you can do to prevent it from happening.

Lora Shahine, M.D., a physician at Pacific Northwest Fertility and IVF Specialists and host of the podcast Baby or Bust, noted that miscarriage is often caused by an abnormality. "The most common cause of miscarriage is a chromosomal imbalance in the embryo—a genetic issue that occurs at fertilization between the egg and sperm," she said.

Chemical pregnancies are not usually an indication of fertility issues, and in many cases, the woman will go on to have a healthy pregnancy at a later date. However, in the case of recurring miscarriages, there can be a few factors that contribute to this, including:

• Thyroid issues
• Blood clotting disorders
• Abnormalities of the uterus
• Autoimmune diseases
• A weak immune system

The symptoms of miscarriage

The most common symptoms of a miscarriage are vaginal bleeding or spotting, abdominal pain and cramping, and abnormal or excessive discharge. These symptoms may come and go over a few days or they may increase in intensity.

With a threatened miscarriage, you may begin to experience light bleeding and cramping. There is no way of knowing whether the pregnancy will continue or whether it will lead to an inevitable miscarriage. An inevitable miscarriage can occur suddenly, causing much stronger cramping and heavier bleeding.

While these symptoms are deeply concerning and will need to be investigated by a doctor, Shahine expressed the importance of not making assumptions. "Some pregnancies with bleeding and cramping go on to full-term and some ectopic pregnancies can present with bleeding and spotting."

On the other hand, some miscarriages can be silent and present very few symptoms.

With a missed miscarriage, the body will not recognize the loss, so the placenta will continue to release pregnancy hormones. You may continue experiencing pregnancy symptoms and, therefore, it could take you a long time to notice any subtle changes, such as a decrease in nausea and breast tenderness. Sometimes, you may have some brown or reddish discharge, and this can be a very telling sign that you are miscarrying.

Treatment options

A chemical pregnancy does not usually require treatment. However, you may experience stronger cramping and bleeding that could last up to two weeks.

"For miscarriage in the first trimester, a person can wait for their body to pass the pregnancy on its own time, use medication to start the miscarriage process, or have a procedure to remove the pregnancy from their body," White said.

If someone experiences a missed or incomplete miscarriage, this often means the cervix is dilated and the miscarriage has begun, but some tissue still remains in the uterus. Many women will experience cramping, heavy bleeding and blood clots around this time. It's important to seek help as soon as any of these symptoms begin because if the tissue isn't removed quickly, it can lead to an infection.

Recurring miscarriages affect around 1 percent of couples trying to conceive. If you have had three or more miscarriages in a row, you will likely be referred to a specialist who will conduct further testing to get to the root cause. If the cause is found and treated, then it's possible to prevent further miscarriages.

"Some patients use IVF with chromosomal screening of embryos before transfer to decrease risk of miscarriage," said Shahine, author of "Not Broken: An Approachable Guide to Miscarriage and Recurrent Pregnancy Loss."

Recovery

Recovery will look different for everyone. While some women will continue with their daily activities, other women may need additional time to rest and adjust.

"Physically, most people can return to work or school three days after a miscarriage, but it's wonderful to get more time off for emotional recovery when that's possible," White said.

If you have to have surgery to remove the remaining tissue in the womb, which is often the case with an incomplete and missed miscarriage, you will usually be able to go home the same day. However, you may still continue to experience stomach cramps and discomfort. It may be advised that you avoid strenuous activities for a few days and seek support from loved ones.