Miscarriage symptoms: signs, causes and care afterwards

In short: The most common miscarriage symptoms are vaginal bleeding, cramping or pain in the lower tummy or back, and sometimes passing clots or tissue. Most early miscarriages happen because of a chromosome problem in the developing pregnancy, not because of anything the woman did. Bleeding in pregnancy does not always mean a miscarriage. See a gynaecologist the same day if you are pregnant and have bleeding or pain.

A miscarriage is the loss of a pregnancy before the baby can survive outside the womb. Most happen in the first 12 weeks, often before a woman has told anyone she is pregnant.

If you are reading this because you are worried, or because it has already happened, please be gentle with yourself. Miscarriage is far more common than people talk about, and nothing you did caused it. Your feelings, whatever they are, are valid.

What are the signs of a miscarriage?

The signs can be different for every woman. Common ones include:

• Vaginal bleeding, from light spotting to heavy bleeding with clots
• Cramping or period-like pain in the lower tummy
• Pain in the lower back
• Passing fluid, clots or tissue from the vagina
• Pregnancy symptoms like nausea or sore breasts suddenly fading

Some women have no symptoms at all, and the miscarriage is only found at a routine scan. This is sometimes called a "missed" or "silent" miscarriage.

Is it bleeding in pregnancy or a miscarriage?

Bleeding in early pregnancy is common, and many women who bleed go on to have healthy babies. Implantation, a sensitive cervix after sex, or an infection can all cause spotting.

Bleeding that gets heavier, comes with cramps, or includes clots or tissue makes a miscarriage more likely. But you cannot tell for sure from the bleeding alone. An ultrasound, and sometimes repeat blood tests, is how a doctor finds out.

Late period or early miscarriage?

Sometimes a very early miscarriage happens around the time a period is due, and it can feel like a heavier or more painful period than usual. You might notice larger clots or greyish tissue.

If your period was late, you have had a positive pregnancy test, or your bleeding feels very different from your usual periods, see a doctor. A blood test or ultrasound can tell you what is happening. If your period is late and your test is negative, read about other reasons in late or missed period but not pregnant.

Why does a miscarriage happen?

Most early miscarriages happen because the pregnancy did not develop properly from the start, usually due to a chance problem with the chromosomes. This is not inherited and is very unlikely to be caused by anything the parents did.

Other possible reasons, especially for later or repeated miscarriages, include:

• Problems with the shape of the womb, or fibroids
• A weak cervix that opens too early
• Thyroid problems or diabetes that is not well controlled
• Some infections
• Blood clotting conditions
• Older age of the mother, as the chance of chromosome problems rises with age

Often, no clear cause is ever found. That can be hard to accept, but it usually means nothing is wrong with your body for a future pregnancy.

What does not cause a miscarriage

Many women blame themselves. Please know that these things do not cause a miscarriage in a healthy pregnancy:

• Normal daily work, including office work or housework
• Gentle exercise, walking or climbing stairs
• Having sex
• A mild fall or a bump
• Feeling stressed, sad or anxious, or having an argument
• Eating ripe papaya, pineapple or spicy food as part of normal meals
• Travelling

Smoking, alcohol and some infections can raise the risk, which is why doctors advise avoiding them in pregnancy.

When to see a gynaecologist

If you are pregnant and have any bleeding or pain, call your gynaecologist.

Go to a doctor the same day if:

• You have bleeding or cramping at any stage of pregnancy
• You have a positive pregnancy test with pain or bleeding
• You think you have passed pregnancy tissue
• You have had a miscarriage and the bleeding is not slowing down

Go to the hospital emergency straight away if:

• Bleeding is heavy, soaking a pad every hour
• You have severe or one-sided tummy pain, or pain in the shoulder tip
• You feel faint, dizzy or collapse
• You have a fever, chills, or foul-smelling discharge after a miscarriage

One-sided pain with a positive test can be a sign of an ectopic pregnancy (a pregnancy outside the womb), which is an emergency.

Care afterwards, and grieving

Your doctor will check whether any pregnancy tissue is left in the womb, usually with an ultrasound. Sometimes the body passes everything naturally. Sometimes the doctor will suggest treatment or a small procedure to empty the womb. They will explain your choices.

In the weeks after:

• Use pads, not tampons or cups, until the bleeding stops
• Rest, eat well, and include iron-rich foods like dal, green leafy vegetables and jaggery
• Your period usually returns within a few weeks
• Ask your doctor when it is safe to have sex and to try again. Many women can try once they feel ready, physically and emotionally

The loss can bring grief, guilt, anger or numbness, and partners grieve too. It is okay to cry, to take time off, and to ask for help. Talk to someone you trust, and tell your doctor if you feel low for weeks or cannot cope. Our guide to grief vs depression may help you understand what you are feeling. You can also call Tele-MANAS, India's free mental health helpline, on 14416. If you have had two or more miscarriages, ask your gynaecologist about tests to look for a cause.

Questions women ask

Miscarriage kaise hota hai?

Most early miscarriages happen because the pregnancy did not develop properly from the start, usually due to a chance chromosome problem. The body then ends the pregnancy, which causes bleeding and cramps. It is not caused by work, sex or normal food.

What does miscarriage bleeding look like?

It can start as brown or pink spotting and become heavier and bright red, often with cramps. You may pass clots or greyish tissue. Any bleeding in pregnancy should be checked by a doctor the same day.

How do I know if it is a late period or an early miscarriage?

It can be hard to tell. A very early miscarriage can feel like a heavier, more painful period. If you had a positive test, a late period, or bleeding unlike your usual periods, a blood test or ultrasound can confirm what happened.

Is all bleeding in pregnancy a miscarriage?

No. Many women have spotting in early pregnancy and go on to have healthy babies. But bleeding with cramps, clots or tissue makes a miscarriage more likely, so always let a doctor check you.

Did I cause my miscarriage?

Almost certainly not. Most miscarriages are caused by chromosome problems that happen by chance. Work, exercise, sex, stress and normal foods do not cause a miscarriage in a healthy pregnancy.