Overview of Pregnancy Loss

What is pregnancy loss?

Pregnancy loss is the death of an unborn baby (fetus) at any time during pregnancy. Pregnancy loss may occur in as many as 1 in every 4 pregnancies. Most pregnancy losses happen during the first trimester. This is often so early that the birth parent doesn’t even know they are pregnant. Pregnancy loss includes:

• Embryonic pregnancy. The egg is fertilized, but it never develops into an embryo.
• Miscarriage. This is pregnancy loss before 13 weeks of pregnancy. It's also called spontaneous abortion.
• Ectopic pregnancy. The fetus develops outside the uterus. This might be in a fallopian tube, the cervix, or the pelvis or abdomen.
• Molar pregnancy. The placenta and fetal tissues do not develop normally.
• Stillbirth. This is when the fetus dies after 20 weeks of pregnancy.

What causes pregnancy loss?

About half of early pregnancy losses are from problems with genes or chromosomes. But other things can also play a role. It's usually not caused by anything the birth parent did. Things that may play a role include:

• Abnormal embryo development
• Hormone problems in the birth parent. These include low levels of progesterone or a thyroid problem.
• High blood pressure or diabetes in the birth parent
• Problems in the uterus. These include scar tissue inside the uterus, abnormally shaped uterus, or fibroids.
• Opening of the uterus can't stay closed during pregnancy (incompetent cervix)
• Infection from germs. These include cytomegalovirus (CMV), mycoplasma, chlamydia, ureaplasma, listeria, or toxoplasma.
• Autoimmune diseases, such as lupus. These cause the body to make antibodies against its own normal tissues. Other autoimmune problems include antiphospholipid antibody syndrome.
• Injury or trauma
• Exposure to toxic substances and chemicals, such as anticancer medicines

When pregnancy loss happens 3 or more times, it's called recurrent pregnancy loss. It's often hard to find a cause for recurrent losses. Couples may need more testing.

Who is at risk for pregnancy loss?

Most pregnancy losses are single events. A person with an early pregnancy loss without a known cause has a very good chance of a normal pregnancy in the future.

Some things can make a pregnancy loss more likely. They include:

• Being an older person
• Having a pregnancy loss in the past
• Smoking cigarettes
• Using alcohol
• Drinking more caffeine
• Using cocaine
• Having a low folate level. Folate is a B vitamin.
• Being underweight or overweight

What are the symptoms of pregnancy loss?

Vaginal bleeding is the most common symptom of pregnancy loss. In later pregnancy, a pregnant person with a stillborn may no longer feel fetal movements. But each type of loss has its own symptoms. Always see your healthcare provider for a diagnosis.

How is pregnancy loss diagnosed?

Your healthcare provider will review your health history and physical exam. Tests to diagnose pregnancy loss may include:

• Pregnancy blood tests. These will look for the hormone human chorionic gonadotropin (hCG).
• Ultrasound. This test uses sound waves and a computer to make images of blood vessels, tissues, and organs.

Sometimes the cause of a pregnancy loss can’t be found with a single blood hCG test or a single ultrasound. You may need repeat testing to confirm the diagnosis. 

How is pregnancy loss treated?

Your healthcare provider will discuss the best treatment with you based on:

• How old you are
• Your overall health and health history
• How well you can handle specific medicines, procedures, or therapies
• Your opinion or preference

Once pregnancy loss occurs, the fetal tissues must be removed from the uterus to prevent further complications. How this is done depends on the week of pregnancy and the type of loss. In early pregnancy loss, your body may naturally get rid of all of the pregnancy tissues. Sometimes the healthcare provider may give you medicines to cause your body to absorb the tissues or to get rid of them more quickly. Other times, you may need surgery to remove the tissues. Talk with your provider about the treatment that is best for you.

Counseling and supporting the family are important. Your healthcare provider can help you find resources and support groups that can help after pregnancy loss.

What are possible complications of a pregnancy loss?

Some pregnancy losses do not cause any problems. Others may be very serious and life-threatening for the birth parent if not treated.

The most difficult part for most families is the emotional stress of the loss itself. Families often have a grief reaction to a loss. This reaction includes:

• Shock, numbness, denial, and confusion
• Anger, guilt, searching, and yearning
• Disorientation, depression, withdrawal, or lack of energy
• Reorganization or resolution

These are normal responses to loss. They may take months and sometimes years to work through.

Can pregnancy loss be prevented?

Most of the time pregnancy loss can't be prevented. Getting good prenatal care is always important.

How is pregnancy loss managed?

Many grieving families have found the following to be helpful:

• Seeing or holding the baby if possible. This is especially important in later pregnancy losses and with babies with a birth defect who die.
• Remembrances. These include a lock of hair, hand or footprint, photographs, or naming of the baby.
• Counseling with a professional who is experienced in grief counseling
• Holding a memorial or funeral service

Key points about pregnancy loss

• Pregnancy loss is the death of an unborn baby (fetus) at any time during pregnancy.
• Pregnancy loss occurs in up to 1 in every 4 pregnancies. Most happen during the first trimester. 
• About half of early pregnancy losses are from defects in genes or chromosomes.
• Vaginal bleeding is the most common symptom of pregnancy loss.
• The loss of a baby at any time in pregnancy can be emotionally and physically hard for the mother and other members of the family. Counseling and support of the family are important.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.