Miscarriage FAQ

An Expert Gives Answer to Your Miscarriage Questions

By Dr. Michael Benson, MD

An old Karen Carpenter song includes the refrain "Rainy days and Mondays always get me down." Alas, for doctors and their patients miscarriages are always a sad and frustrating event.

Miscarriages almost always result from some problem with the developing embryo. The problem is typically a deformity severe enough that the future baby would not be able to survive outside the womb even if the miscarriage did not take place. Paradoxically, it is this fact that friends and relatives will use in an effort to comfort the patient with the expression, "the miscarriage was a blessing in disguise." My experience is that this comment, however true it may be, seems to fail in its intended purpose to reduce the distress of the experience.

It is worth emphasizing that miscarriages reflect embryonic malformations and rarely result from some problem with the mother's health. This fact is reflected in the statistics that show that women who have had one miscarriage do not have a significantly increased chance of miscarrying again. Even those with two or three consecutive miscarriages are more likely than not to have a successful pregnancy the very next time.

Medication almost never causes miscarriages. Similarly, maternal activity such as exercise and sexual intercourse is not a factor. Women can no more shake a healthy embryo loose from its attachment to the uterus than they can tear their own kidneys or intestines from their blood supply or attachments.

It is useful to think of the miscarriage process as having two separate steps. The embryo first dies and days, weeks, or even months later it is then passed from the body. The expulsion of the embryo from the uterus is a highly variable experience among women but typically involves bad cramping and heavy bleeding from 15 minutes to 12 hours. Given the unpredictability of the actual passage of tissue coupled with its unpleasantness, many obstetricians will offer patients the option of having a D and C after they are sure of embryonic demise. More properly known in this instance as a suction curettage, this brief procedure removes the pregnancy tissue before it is actually expelled by the body.

The chief symptom of a potential miscarriage is vaginal bleeding. Perhaps one-third of women will have some bleeding in the first trimester though only half will go on to miscarry. Contrary to popular opinion (and some childbirth texts) mild cramping without bleeding and the disappearance of morning sickness or breast tenderness are common occurrences in healthy pregnancies and are not symptoms of an impending miscarriage.

Though there is little that can be done to prevent a miscarriage, obstetricians can investigate the health of the embryo in those who are bleeding through ultrasounds and serial blood pregnancy tests (HCGs). An ultrasound that demonstrates an embryonic heartbeat or blood pregnancy test levels that rise when drawn two days apart can be reassuring.