Loads of us worry about miscarriage when we're pregnant, especially if we notice some spotting, bleeding or cramping. Or maybe when we realise that the pregnancy symptoms we were having (morning sickness, sore breasts or tiredness, for example) suddenly disappear.
So how can you tell if it's nothing to worry about or if, sadly, your pregnancy may end up being one of the 1 in 4 pregnancies that ends in miscarriage?
I'm bleeding: am I having a miscarriage?
It's true that the main symptoms of miscarriage are usually vaginal bleeding or spotting, either with or without abdominal pain or cramping.
"But it's important to know that spotting or bleeding when you're pregnant doesn’t necessarily mean that you are miscarrying or that you will miscarry," says Ruth. In fact, episodes of light bleeding in the first 3 months of pregnancy are pretty common.
However if the bleeding is very heavy or you're passing blood clots or thick pink or grey material, call a doctor straightaway.
"And," says Ruth, "if you're getting spotting or light bleeding – either continuously or on and off – over days or even weeks, it’s worth checking with your GP or midwife. They might refer you for a scan at an early pregnancy unit to see if you're miscarrying or not."
I've got cramps in my tummy: am I having a miscarriage?
Cramping or pain in your lower tummy is a potential sign of miscarriage – but again, it's common to experience mild cramping in early pregnancy without it meaning anything untoward.
If you're having spotting or bleeding as well as the cramps, or if the cramps are becoming more painful (or, if you're later on in pregnancy, the cramps are getting more intense, like contractions), see your GP or midwife.
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If the pain is one-sided, severe or you can't manage it even with pain relief, it is important to seek medical advice – even if there is no bleeding.
"And, if you're feeling an acute pain, with other symptoms such as shoulder-tip pain, vomiting, light-headedness, diarrhoea and pressure or pain in your bowel when you're going to the toilet," says Ruth, "go to your nearest A&E: you may be experiencing an ectopic pregnancy (where the fertilised eggs has implanted outside, rather than inside, your womb) and that needs urgent medical treatment."
My pregnancy symptoms have disappeared: am I having a miscarriage?
Pregnancy symptoms can come and go – and some of us don't really experience many at all. The symptoms – and their intensity – can also vary from pregnancy to pregnancy: so you may have felt very sick during your 1st pregnancy and not feel at all nauseous during your 2nd.
But, says Ruth, if you're not 12 weeks pregnant and you've been having strong pregnancy symptoms (particularly breast tenderness or morning sickness) that have now suddenly reduced or stopped, it might mean that your hormone levels are dropping in response to a miscarriage. You may want to do another pregnancy test and/or talk to your GP about perhaps having a scan.
What if I'm still not sure?
"If you’re anxious, bleeding, in pain or just uncertain in any way," says Ruth, "it’s always a good idea to contact your GP or midwife. They can assess what’s happening and they may refer you for an ultrasound scan or other check-up – for reassurance.
"You can also always get in touch with the Miscarriage Association (we have a forum, a Facebook page, an online Live Chat and a helpline on 01924 200799 that's open Monday to Friday, 9am to 4pm). We can offer you information and a safe space to talk things through."
There are lots of different miscarriage terms: what do they all mean?
Doctors can use different terms because there are many different causes and presentations of miscarriage. Here are some of the most common:
Early miscarriage: This is the term for a miscarriage that occurs in the first 12 weeks of pregnancy. It is thought that around half of early miscarriages are due to random (one-off) genetic (chromosonal) faults in the egg or the sperm. Sometimes, it can be due to a problem with how the placenta's forming, too.
Late miscarriage: This is the term for a miscarriage that happens between 13 weeks and 24 weeks of pregnancy. (A baby loss after the 24th week is officially called a stillbirth). Causes can include infection, a weakness in your cervix (neck of the womb) or some underlying health condition. It is much less common that early miscarriage.
Chemical pregnancy: This is the term to what happens when a sperm fertilises your egg but, later on, the egg fails to survive. It happens very early on in pregnancy – about the 5th week – so, unless you've done a very early pregnancy test, you may never even know it's happened.
Threatened miscarriage: This is the term used by medics when you have reported some vaginal bleeding or spotting and it's clear that the neck of your womb (cervix) is still closed. It does not necessarily mean that miscarriage is going to happen; the bleeding may well stop, and you go on to have a healthy baby.
Missed (or silent) miscarriage: This is when your baby has died but is still in your womb (so you may not have had any spotting or bleeding or pains). You may still feel pregnant and have positive pregnancy tests. Often, you don't know anything has happened until you have a routine scan and the sonographer has to break the news that they can't find a heartbeat.
Blighted ovum (sometimes called early embryonic loss): This the term used when a pregnancy sac can be seen on an ultrasound scan but there is nothing inside it. What that means is that, although the embryo has not developed, the sac that contains it has continued to grow. Often, because the sac is still growing, and you still feel pregnant and have a positive pregnancy test, blighted ovum will be a missed miscarriage (see above) and you will not find out about it until you have a routine scan.
Ectopic pregnancy: This happens when the embryo implants outside your womb, usually in one of your Fallopian tubes. The embryo cannot develop into a baby – and, if you don't get medical attention, you could suffer potentially life-threatening bleeding.
Molar pregnancy: This happens when the cells that normally form a placenta grow into a clump of abnormal cells instead – and this means your baby cannot develop.
About our expert: Ruth Bender Atik
Ruth Bender Atik has been National Director of the Miscarriage Association since 1993. She is a qualified social worker and has written guidance for NHS staff on Caring for Patients with Pregnancy Loss.
Images: Getty Images
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