Miscarriage: Factors that put you at high risk

Miscarriage is more common than many people realise. Understanding the facts can help you make sense of what’s happening, know what to expect, and find a way forward. Here is more about miscarriages.

Between eight and 20 percent of people who know they are pregnant will experience a loss before 20 weeks, and 80 percent of these occur within the first 12 weeks.

The true number is likely higher, as some losses happen so early that they are mistaken for a slightly heavier period with stronger cramps. Because this may occur around the expected menstrual date, many never realise it was a miscarriage.

Symptoms of pregnancy - and what it means if they stop?

Early pregnancy symptoms can include nausea, breast tenderness, fatigue, sleepiness, heartburn, bloating, constipation, mild cramping, and frequent urination. These vary greatly - some women feel no symptoms at all, while others have severe symptoms requiring hospital care.

Symptoms often improve after the first trimester. A sudden change or disappearance of symptoms does not always mean something is wrong; they can naturally fluctuate.

However, if this happens alongside vaginal bleeding or persistent cramping, it may indicate the pregnancy is no longer developing and should be checked promptly.

Risk factors to look out for

Most miscarriages are not caused by anything the pregnant person did or didn’t do - and in many cases, they are unpredictable and unpreventable.

Common causes can include chromosomal abnormalities. This is the most common cause, preventing the embryo from developing normally. These are mistakes in the baby’s genetic instructions that happen when the egg and sperm first join.

If the number or arrangement of these chromosomes is wrong, the baby cannot develop normally, and the pregnancy ends naturally. This is the most common cause of miscarriage and usually happens by chance, not because of anything the parents did.

Certain health problems can increase the risk of miscarriage, especially if they are not well controlled. Examples include diabetes (when blood sugar is poorly managed), thyroid disorders, some infections, and problems with the shape or structure of the uterus that make it harder for a pregnancy to grow safely.

The risk of miscarriage rises after age 35. This is mainly because eggs are more likely to have chromosomal abnormalities as a woman gets older, which can affect the baby’s development.

Smoking, drinking alcohol, and using certain recreational or illegal drugs can harm a developing pregnancy and increase the chance of miscarriage.

A high fever (above 38°C / 100°F) early in pregnancy, or a significant injury to the uterus, can raise the risk. Minor bumps are usually cushioned by the pelvis and amniotic fluid, but more serious trauma may be harmful.

Having had a miscarriage before can slightly increase the risk of another, but most women go on to have healthy pregnancies in the future.

What is a missed miscarriage?

In a missed miscarriage, the embryo or foetus has stopped developing, but there are no symptoms such as bleeding or pain. It is usually discovered during a routine scan when no heartbeat is seen at a stage when it should be visible.

What are the warning signs of miscarriage?

These include vaginal bleeding from light spotting to heavy flow with clots, lower abdominal or back pain, passing fluid or tissue from the vagina, loss of pregnancy symptoms, especially if combined with the above; light bleeding or mild cramps can still occur in healthy pregnancies, so only a medical assessment can confirm a miscarriage.

How is a miscarriage managed?

There are three main management options your doctor will discuss with you. All are safe, and in most cases, the long-term outcomes are similar.

We usually recommend surgery urgently if bleeding is heavy and life-threatening, but otherwise, the choice is yours. Each has its pros and cons:

Natural/Expectant management. This means allowing your body to pass the pregnancy tissue on its own. The process can take days to weeks and is often accompanied by heavy bleeding and cramping. It is non-invasive, has no side effects from medication, and is the least costly. The problem with this method is that it may not work fully, and you may still need medication or surgery later.

Medical management involves the use of medication to make the uterus contract and pass the tissue. It is faster than natural management, less expensive than surgery and can be done at home.

The downside of this method is that it has side effects such as fever, diarrhoea, and pain. In some cases, it may still require surgery if the process is incomplete.

Surgical management. A minor procedure such as uterine aspiration, dilation and curettage or manual vacuum aspiration to remove the pregnancy tissue. The advantage of this is that it’s the quickest method, most likely to succeed and allows testing of tissue if needed. It is, however, more expensive, requires anaesthesia, and carries small risks from surgery and anaesthesia.

How long will it take to recover?

Physically, bleeding usually settles within 1–2 weeks. Avoid vaginal sex, tampons, or douching for about two weeks to reduce infection risk. If blood group Rhesus negative, you may be given an injection to prevent complications in future pregnancies.

Emotionally, grief, sadness, anger, and guilt are all common. Healing emotionally may take much longer than physical recovery. Support from loved ones, counselling, or support groups can help.

When should we try again?

Ovulation can return as soon as 2–4 weeks after a miscarriage. For most, there is no medical need to delay trying again unless advised otherwise. The right time is when you feel physically and emotionally ready.

What are the chances of a miscarriage recurring?

Most people who have had one miscarriage will have a healthy pregnancy next time. Risk is slightly higher after two or more consecutive losses, in which case further investigations may be recommended.

Can a miscarriage be prevented?

While not all miscarriages can be prevented, you can reduce risk by avoiding smoking, alcohol, and recreational drugs, managing chronic medical conditions before and during pregnancy through a preconception clinic visit, maintaining a healthy weight and balanced diet and avoiding harmful substances and infections.

Please remember that miscarriage is rarely anyone’s fault. If you experience bleeding, pain, or a sudden loss of pregnancy symptoms, seek prompt medical care. Though the loss can be devastating, many go on to have healthy, successful pregnancies in the future.

Dr Joan Okemo  is a Consultant Obstetrician Gynaecologist at Aga Khan University Hospital