Miscarriage: When to See a Doctor

Miscarriage: When to See a Doctor

Nicole Knight, AHCJ | October 4, 2019 | Getting Pregnant

Losing a pregnancy can be heartbreaking. Sadly, miscarriages are relatively common.

According to the American College of Obstetricians and Gynecologists (ACOG), 1 in 10 clinically recognized pregnancies end in a miscarriage, and 80% of those end in the first trimester (1). The percentage of miscarriages may reach as high as 31% when you take into account losses that happen before the pregnancy is confirmed by a doctor (2).

Still, you can take heart in the knowledge that having a miscarriage doesn’t prevent you from having a full-term pregnancy in the future. A study of 53,000 women found 43% had experienced one or more first-trimester pregnancy losses before going on to have a healthy pregnancy (2).

If you’re worried you’re having a miscarriage, you may wonder whether bleeding is normal or a reason to see a doctor. Or if you’ve already experienced one or two miscarriages (we’re so sorry 💔) you may wonder if it’s time to see a specialist.

Here, we explore these heart-rending questions and others.

I’m bleeding and cramping — am I having a miscarriage?

The first thing to know is that bleeding in the first trimester of pregnancy is fairly common, occurring in 20-30% of pregnancies (2). What’s more, most women with first-trimester bleeding don’t go on to have a miscarriage (2).

If you’re bleeding and cramping, you may panic thinking you’re having a miscarriage. Bleeding doesn’t necessarily mean you’re having a miscarriage (2). It does mean you should contact your doctor (even if you’re just 6 or 7 weeks along) to rule out pregnancy complications, which we’ll get to in a sec (2).

The amount of bleeding during early pregnancy can vary considerably and isn’t a reliable guidepost to determine whether you’re having a miscarriage (2). Cramps also run the gamut and may come and go. However, severe cramps may indicate you’re passing pregnancy tissue (2). Passing tissue or blot clots are potential signs of early pregnancy loss and another reason to call your doctor (2).

When should I see a doctor if I'm bleeding or cramping during pregnancy?

Bleeding and cramping are potential signs of pregnancy complications, including an ectopic pregnancy or molar pregnancy, which is when a nonviable egg implants in your uterus (2). See your doctor for an evaluation if you’re experiencing bleeding or cramping during your pregnancy, even if you’re just in the very early stages of pregnancy (2). Your doctor will want to rule out pregnancy complications.

Your doctor will likely perform a pelvic ultrasound to diagnose your condition and may recommend a series of blood tests to check your levels of human chorionic gonadotropin (hCG) and progesterone (2). A widely used doctor’s manual suggests you’re very likely having a miscarriage if you’re bleeding AND your hCG level drops more than 25% over 48 hours (2).

I've had two miscarriages — should I see a doctor?

ACOG recommends seeing a doctor if you’ve experienced two miscarriages in a row (1). Although miscarriages are common, consecutive losses are rare. Estimates suggest that fewer than 5% of women experience two successive miscarriages, and only 1% experience three or more in a row (3). Meanwhile, the American Society for Reproductive Medicine defines recurrent pregnancy loss (RPL) as two or more lost clinical pregnancies (3).

Why did I have a miscarriage?

Miscarriages may be related to your age and other factors. Approximately 60% of early pregnancy losses are due to chromosomal abnormalities (3). If you decide to see a doctor after repeat miscarriages, they’ll typically perform genetic tests to home in on the reason (or reasons) for recurrent losses. They may recommend a test called karyotyping, which examines chromosomes in a cell sample to detect any chromosomal abnormalities (3).

Between 5-20% of women who experience repeated miscarriages have certain antiphospholipid antibodies in their blood (3). (Side note: about half of people with lupus have these antibodies (4).) Your doctor may recommend testing for antiphospholipid antibodies as part of your workup. Treatment for these antibodies typically includes aspirin or other blood thinners (3).

What if I have irregular cycles and have a miscarriage or repeated miscarriages?

An irregular cycle may be tied to an underlying hormonal issue that may make you more prone to miscarriages.

For example, the hormone progesterone, plays an important role in your menstrual cycle and is necessary to maintain an early pregnancy (5). Producing too little progesterone prevents your uterine lining from thickening and sends a signal to the lining, telling it to shed too early in your menstrual cycle (6). In pregnancy, a deficit of this crucial hormone may lead to a miscarriage when the fertilized egg lacks a sufficiently nourishing environment to develop (7). Learn more about how progesterone affects your cycle in Progesterone 101 and Progesterone 201.

Prolactin is another hormone that not only affects your cycle but also may raise your miscarriage risk (7). Prolactin is made by your pituitary gland. Producing too much of it can stop your ovaries from making estrogen, which may lead to an irregular cycle or to no period whatsoever (8). Too much prolactin also can disrupt the normal development of your uterine lining, increasing the chances of a miscarriage (7).

Other hormonal issues may affect your ability to maintain a pregnancy. Problems with your thyroid and adrenal glands, or having diabetes, may put you at a higher risk for miscarriage due to hormonal imbalances (7).

We’ve unpacked a lot of information today to assist in your quest for answers about miscarriages. As you arm yourself with knowledge, make sure you also don’t neglect your self-care. Suffering a pregnancy loss or simply feeling afraid you might miscarry are both heart-wrenching experiences, and times when your body — and spirit — deserve extra TLC.

Read a personal story about miscarriage or find emotional support when TTC.

References:

  1. https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Early-Pregnancy-Loss
  2. https://www.uptodate.com/contents/pregnancy-loss-miscarriage-risk-factors-etiology-clinical-manifestations-and-diagnostic-evaluation?search=miscarriage&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2
  3. https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-non-members/evaluation_and_treatment_of_recurrent_pregnancy_loss_a_committee_opinion-noprint.pdf
  4. https://www.hopkinslupus.org/lupus-tests/antiphospholipid-antibodies/
  5. https://www.ncbi.nlm.nih.gov/pubmed/19913373/
  6. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009154.pub3/abstract
  7. https://resolve.org/infertility-101/medical-conditions/multiple-miscarriage/ 
  8. https://www.medicalnewstoday.com/articles/322279.php