Early miscarriage occurs in the first trimester of pregnancy. It’s a fairly common occurrence, affecting an estimated 10%-20% of pregnancies.

​Etiologies:​

  • 50%-60% due to chromosomal mutations
  • Idiopathic or Unknown
  • Progesterone deficiencies
  • Uterine cavity abnormalities
  • Thrombophilia
  • Risks increase with advanced maternal age.


The following actions do not cause an early pregnancy loss:

  • ​Having sex
  • Working and increased activity
  • Exercising or contact sports
  • Using birth control pills before pregnancy
  • Falling
  • Symptoms of Early Pregnancy Loss

​The most common symptoms of an early pregnancy loss are bleeding and cramping, but these are not sure signs. Many women experience these in their first trimester, and their pregnancies continue normally.​

​Diagnosis of Early Pregnancy Loss

​Physical examination, Ultrasound evaluation and follow up serial HCG levels can diagnose and rule out serious conditions such as ectopic gestation.​

​Post Diagnostic follow up

​You need to make sure all the pregnancy tissues are removed from your uterus. There are both surgical and non-surgical options available.​

​Non-surgical post miscarriage care options

​If there’s no risk of infection, it may be possible to allow the tissue to pass naturally, which usually takes 1-2 weeks.

You should expect bleeding that is longer and heavier than your normal period. You may also pass tissue that resembles blood clots. Symptoms can include nausea, diarrhea, and/or painful cramps, for which we can prescribe you medication. Afterward, you should have an ultrasound to make sure all of the tissue has passed.​

​Surgical post miscarriage care options

​If your bleeding is heavy, or if you show signs of an infection, we will recommend surgical removal of the tissue. There are two common procedures:​

​Suction Dilation & Curettage

​It involves inserting a thin tube into the uterus, and using gentle suction to clear out the tissue under local or general anesthesia.​

​Dilation and curettage (D&C)

​It involves dilating the cervix, and using a special instrument to remove all of the tissue. You may receive general or regional anesthesia.​

​Follow up

​To prevent infection, you should avoid vaginal intercourse for 1-2 weeks following the miscarriage. During this time, do not put any objects in your vagina, including tampons and birth control devices.

Signs of infection:

  • Severe Pain
  • Fever
  • Chills
  • Heavy bleeding (going through two or more pads per hour, for longer than two hours)
  • Your OB/GYN will guide you for your future pregnancy plans.
The loss of a pregnancy during the first 13 weeks of pregnancy (the first trimester) is called early pregnancy loss, miscarriage, or spontaneous abortion.
Early pregnancy loss is common. It happens in about 10% of known pregnancies.
About one half of cases of early pregnancy loss are caused by a random event in which the embryo receives an abnormal number of chromosomes. Chromosomes are the structures inside cells that carry genes. Most cells have 23 pairs of chromosomes for a total of 46 chromosomes. Sperm and egg cells each have 23 chromosomes. During fertilization, when the egg and sperm join, the two sets of chromosomes come together. If an egg or sperm has an abnormal number of chromosomes, the embryo also will have an abnormal number. Development will not occur normally, sometimes resulting in loss of the pregnancy.
Some women worry that they have done something to cause their pregnancy loss. Working, exercising, having sex, or having used birth control pills before getting pregnant do not cause early pregnancy loss. Morning sickness does not cause early pregnancy loss. Some women who have had an early pregnancy loss believe that it was caused by a recent fall, blow, or even a fright. In most cases, this is not true. Smoking, alcohol, and caffeine also have been studied as causes of early pregnancy loss. Some research suggests that smoking increases the risk, while other research suggests that it does not. Alcohol use in the first trimester may slightly increase the risk of early pregnancy loss, but the research is not clear. In any case, it is best to avoid smoking and drinking alcohol during pregnancy. Consuming 200 mg or less of caffeine a day (the amount in two cups of coffee) does not appear to increase the risk of early pregnancy loss.
The likelihood of early pregnancy loss occurring increases as a woman gets older. Early pregnancy loss occurs in more than one third of pregnancies in women older than 40 years.
Bleeding and cramping are the most common symptoms of early pregnancy loss. A small amount of bleeding and cramping in early pregnancy is relatively common. Bleeding often stops on its own, and the pregnancy continues normally. Bleeding and cramping also can be signs of other pregnancy problems, such as ectopic pregnancy. If you have any of these signs or symptoms, contact your obstetrician–gynecologist (ob-gyn) or other member of your health care team.
If you have signs and symptoms of early pregnancy loss, you most likely will have a physical exam. Your obstetrician will ask you questions about when the bleeding started, how much you are bleeding, and whether you have pain or cramping. An ultrasound exam may be done to check whether the embryo is still growing in the uterus or to detect the presence of a heartbeat. You may have a test to measure the level of human chorionic gonadotropin (hCG) in your blood. This substance is made by the developing placenta. A low or decreasing level of hCG can mean loss of the pregnancy. Several ultrasound exams and hCG tests may be necessary to confirm that pregnancy loss has occurred.
When a pregnancy is lost, some of the pregnancy tissue may remain in the uterus. This tissue needs to be removed. There are several ways this can be done. If the situation is not an emergency, you can help choose the type of treatment. The available options have similar risks, which include infection and heavy bleeding. The risk of serious complications, regardless of the type of treatment, is very small. If your blood type is Rh negative, you also likely will receive a shot of Rh immunoglobulin after an early pregnancy loss. Problems can arise in a future pregnancy if you are Rh negative and the fetus is Rh positive. These problems can be prevented by giving Rh immunoglobulin after a pregnancy loss.
If you do not show any signs of an infection, one option is to wait and let the tissue pass naturally. This usually takes up to 2 weeks, but it may take longer in some cases. Another option is to take medication that helps expel the tissue.
You will have bleeding. The bleeding usually is heavier than a menstrual period and lasts for a longer time. Cramping pain, diarrhea, and nausea also can occur. Your ob-gyn may prescribe pain medication. You may pass tissue in addition to bleeding. With an early pregnancy loss, the pregnancy tissue resembles a blood clot. It does not look like a baby. An ultrasound exam or blood tests for hCG usually are done afterward to confirm that all of the tissue has been expelled. If it has not, you may need to have surgical treatment.
Surgery is recommended if you have signs of an infection, heavy bleeding, or other medical conditions. One surgical option is called vacuum aspiration. In this procedure, a thin tube attached to a suction device is inserted into the uterus to remove the tissue. The procedure may be performed in your doctor’s office. Local anesthesia is used. You also may be given medication to help you relax. Another option is called dilation and curettage (D&C). In a D&C, the cervix is dilated (opened), and an instrument is used to remove the pregnancy tissue. A D&C usually is done in an operating room or surgical center. General anesthesia or regional anesthesia may be used.

You may be advised not to put anything into your vagina (such as using tampons or having sexual intercourse) for 1–2 weeks after an early pregnancy loss. This is to help prevent infection. Call your ob-gyn right away if you have any of the following symptoms:

  • Heavy bleeding (soaking more than two maxi pads per hour for more than 2 hours in a row)
  • Fever
  • Chills
  • Severe pain
If you or your partner is having trouble handling the feelings that go along with this loss, talk to your ob-gyn or other member of your health care team. You also may find it helpful to talk with a counselor. Support groups—either online or in person—can be helpful. SHARE: Pregnancy and Infant Loss Support, Inc. (www.nationalshare.org) lists local support groups and offers online resources to help with grief and healing.
Pregnancy loss in the first trimester usually is a one-time event. Most women go on to have successful pregnancies. Repeated pregnancy losses are rare. Testing and evaluation can be done to try to find a cause if you have several pregnancy losses. Even if no cause is found, most couples will go on to have successful pregnancies.

You can ovulate and become pregnant as soon as 2 weeks after an early pregnancy loss. If you do not wish to become pregnant again right away, be sure to use a birth control method. You can use any contraceptive method, including having an intrauterine device inserted, immediately after an early pregnancy loss. If you do wish to become pregnant, there is no medical reason to wait to begin trying again. You may want to wait until after you have had a menstrual period so that calculating the due date of your next pregnancy is easier.