Miscarriage occurs when the fetus dies before 20 weeks of pregnancy. Then the fetus is ejected from the uterus before it has fully developed. Typical symptoms include severe abdominal pain and vaginal bleeding. In some cases, no medical treatment is required, but sometimes, if there is still tissue present in the uterus, it needs to be removed.


Almost half of all pregnancies are spontaneously aborted. Often these miscarriages are due to chromosome abnormalities or other developmental problems. Sometimes infection is the cause, but in many cases there is no clear explanation.


Most miscarriages occur early, before 12 weeks. The body usually doesn’t suffer, but miscarriage can be emotionally difficult.


The medical definition of miscarriage is any loss of pregnancy before week 22. Thereafter, the fetus is usually so developed that it has a chance of survival, so it is called a premature birth. In these cases, treatment is required to help the fetus to continue to develop.


If you have a miscarriage, you may have abdominal pain that feels like a severe menstruation, with pain low in the abdomen. Vaginal bleeding is likely and may be mixed with tissue or fluid. Some women also experience back pain.


Most people get severe bleeding first when the uterus ejects the remains of the fetus, followed by mild bleeding for a few days. If the uterus fails to pass the rest of the remaining tissue, the bleeding will continue. In this instance, the body needs help to end the miscarriage. In case of a so-called delayed miscarriage or “missed abortion” you may only get a brownish discharge and the body also may need help to pass the remaining tissue. Any feelings of being pregnant also decrease with the miscarriage.


It is important to remember that bleeding and abdominal pain during pregnancy are not always signs of miscarriage. Bleeding is a common symptom and can be something else – for example, a so-called ‘breakthrough bleeding’ from the uterus, which is a natural sign of the developing pregnancy; the uterus can also bleed in connection with intercourse; or sometimes cervical polyps, infections or hemorrhoids around the anus, can cause minor bleeding.


In more unusual cases, bleeding can be a sign of a more serious condition requiring immediate care. An ectopic pregnancy, which means that the embryo grows outside the uterus, usually causes intense abdominal pain in the low abdomen, often in combination with bleeding.


In the end of pregnancy, placental problems can sometimes cause severe bleeding. Sometimes bleeding can occur in connection with cell changes, but this is uncommon and is usually detected during early prenatal care.


Miscarriage rarely depends on something you can influence and often there is no clear explanation. Research shows that it is often chromosome abnormalities or developmental defects in the fetus that cause a miscarriage. Sometimes this is due to sperm or egg defect; sometimes the abnormality occurs during cell division. In either case, the embryo cannot develop and the pregnancy ends itself.


Misacarriage may also be caused by infections in the uterus or if the egg hasn’t attached properly to the uterus. Late miscarriage, after 12 weeks, is sometimes caused by cervical problems. In some cases, defects in the placenta can also cause a miscarriage. Serious, external damage can also cause miscarriage, although this is less common.


Uterine pregnancy, which means that the embryo developes outside the uterus, always causes miscarriage, because it is impossible for the body to complete a pregnancy this way.


Risk factors associated with miscarriage include:


  • alcohol, smoking and drugs
  • age
  • body trauma
  • severe overweight
  • hormonal disorders (such as thyroid problems or lack of progesterone)
  • chronic diseases (for example, diabetes)
  • infections 
  • problems with the uterus or cervix

Prevention and Protection

To increase your chances of getting pregnant and to avoid miscarriage, there are some things to keep in mind:


  • Take prenatal vitamins 
  • Don’t forget regular prenatal care throughout pregnancy
  • Avoid caffeine, alcohol, smoking and drugs
  • Try to lose weight if you are overweight
  • Avoid medicines if possible (many medications can have a negative effect – read the instructions carefully or ask your doctor or pharmacist)
  • Eat a healthy diet


If you have chronic illness such as diabetes, it is advisable to consult a doctor before and during pregnancy, as there may be an increased risk of miscarriage.


In order to detect a miscarriage, a gynecological examination is often performed with a vaginal ultrasound. An early miscarriage sometimes requires no treatment at all, but the body may also need help to remove all tissue present in the uterus. Then you will either receive medical treatment in the form of tablets, or have any remaining tissue surgically removed.


People who have suffered from multiple miscarriages with the same partner need to undergo a medical investigation to find the underlying cause. In this case, the uterus, eggs, and sperm are all checked. In case of miscarriages that occur late, the cervix is ​​usually examined. In case of a new pregnancy, the cervix may sometimes need to be strengthened with the help of a band attached around the cervical spine.

When to consult a doctor

If you are pregnant and have prolonged bleeding, you have probably suffered a miscarriage. If you have only abdominal pain and the bleeding subsides after about a week, you generally do not need to see a doctor. It is normal to continue with some light bleeding, for another couple of weeks. If bleeding increases, you should contact a doctor. This also applies to any bleeding that smells bad.


If you are unsure if this is really a miscarriage, you should get medical advice. In the first half of pregnancy, you can get help from a gynecologic clinic. Bleeding after week 22 should always be followed up by a maternity ward, even if the bleeding is light.


If you are pregnant or think you are having a miscarriage and have severe abdominal pain or bleeding, contact an emergency room. If you are bleeding less but feel generally sick with dizziness or fever, you should also seek help immediately.

How APPOTEK can help

For severe abdominal pain, severe bleeding and fever, you need urgent medical attention.


But if you need advice and information about a miscarriage, APPOTEK can help you. A nurse or doctor will make an individual assessment based on your symptoms during the consultation. You may then be referred for further care – in case of miscarriage a physical examination is sometimes required.


If you need to talk to someone and get help processing your feelings, you can talk to a psychologist. We offer continuous follow-up and return visits to the psychologist, as many times as you want and need.


Valeria Chernikova, Neurologist, M.D.