Miscarriage

Miscarriage is the loss of a pregnancy before 20 weeks. It is extremely common — roughly 1 in 4-5 recognised pregnancies end in miscarriage, most in the first trimester. Most happen because of chromosomal problems in the embryo, not because of anything the woman did or didn't do.

Symptoms

• Vaginal bleeding in early pregnancy — light to heavy, sometimes with clots.
• Cramping lower-abdominal pain.
• Sudden loss of pregnancy symptoms (nausea, breast tenderness) — may or may not be significant.
• Passing tissue through the vagina.
• Some miscarriages are silent — found only on ultrasound; the woman may have no symptoms.

Red flags — dial 112 or go to hospital

• Heavy bleeding soaking a pad every hour.
• Severe abdominal pain, especially one-sided — possible ectopic pregnancy, needs urgent care.
• Fainting, light-headedness, rapid heartbeat.
• Fever — possible infection.

Management

• Expectant — waiting for the uterus to empty naturally, with monitoring.
• Medical — medicines to help the uterus empty.
• Surgical (D&C / evacuation) — quick, often under anaesthesia; for incomplete or inevitable miscarriages.
• Anti-D injection if the woman is Rh-negative — important for future pregnancies.
• All three approaches are safe when chosen appropriately; decision depends on the stage, bleeding, infection risk, and woman's preference.

Recurrent miscarriage

Three or more miscarriages deserves evaluation — antiphospholipid syndrome, thyroid disease, uterine anomalies, genetic factors, severe diabetes, and chronic endometritis are treatable causes. Many women who have had two or three miscarriages still go on to have a healthy pregnancy.

The emotional side

• Grief, guilt, anger and anxiety are normal after miscarriage — even an "early" one.
• Miscarriage is not your fault — usual everyday activities (exercise, sex, lifting a small child, mild stress) do not cause miscarriage.
• Don't rush to "get over it." Talk to someone; consider counselling if grief persists.
• Plan the next pregnancy when you feel ready — there is no strict medical waiting period for most women.
• Partner and family support matters — miscarriage affects couples, not just women.