Understanding mis­carriage: causes, frequency and ways of coping

Many pregnancies end in miscarriage

Miscarriage is rarely talked about, even though it’s common. An estimated 10-15% of medically recognised pregnancies end in miscarriage, amounting to around 23 million worldwide each year. Some pregnancies are only detectable in laboratory tests, and the mothers aren't even aware of having been pregnant.

Coping with miscarriage

At the moment a miscarriage is diagnosed, many parents feel as though their world has fallen apart. For many, it comes as a profound shock, leaving them feeling numb, empty and shrouded in fog. Deep and heavy grief can set in, which is often difficult to process.

Many people find comfort in giving the child a place in their lives, even if it couldn’t stay.

Time for grief and connection

Taking time is essential for many at this stage. Time to feel, to understand and to say goodbye at their own pace. Rituals such as a burial can help honour the relationship with the child and offer comfort through a sense of lasting connection.

Finding support

After the early loss of a child, parents can find support from a range of people and organisations:

Physical recovery after miscarriage

In many cases, the body recovers relatively quickly after a miscarriage. Depending on the stage of pregnancy, this can take one or two weeks or up to a month. Alongside physical recovery, it’s just as important to process the miscarriage emotionally.

Causes of miscarriage

Depending on when a miscarriage occurs, the causes can vary widely. During the first 12 weeks of pregnancy, the most common cause is genetic abnormalities, known as chromosomal anomalies. These make normal development of the embryo impossible.

In addition to genetic factors, other influences may also play a role. Often, a miscarriage is the result of several factors combined:

• Malformations of the uterus or fibroids that prevent implantation of the fertilised egg
• Infections, for example of the cervix, uterine lining or placenta
• Medical conditions such as diabetes, an overactive thyroid or underactive thyroid
• Blood-clotting disorders
• Harmful lifestyle factors such as smoking, alcohol or drug use
• Maternal age: Miscarriages are generally more likely in older women
• Damage to sperm DNA, for example due to age, smoking or environmental toxins

Not a personal failure, but a common experience

In many cases, no clear cause can be identified and the miscarriage couldn't have been prevented. A miscarriage is not the result of a personal mistake or failure. It’s a painful but common experience that many women and couples go through.

Miscarriage caused by caffeine?

Studies suggest that consuming more than about two cups of coffee a day may increase the risk of miscarriage. However, the scientific evidence for the link is complex and remains a subject of debate among experts.

What doesn't cause a miscarriage

After a miscarriage, many women ask themselves whether they did something “wrong” – whether a specific action, a cup of coffee or carrying a heavy bag could have been the cause. These thoughts are understandable, and there are many myths about what can trigger a miscarriage.

Most of the following ideas can be medically disproven:

1. Incorrect movement or physical activity: Normal movement, exercise during pregnancy or an awkward twist doesn't cause miscarriage.
2. Colds: A common cold with a runny nose is harmless.
3. Everyday activities: Shopping or housework poses no risk.
4. Not eating or drinking enough: Temporary loss of appetite isn't harmful. Severe malnutrition, however, can be risky.
5. Spicy food: Highly seasoned food has no effect on pregnancy.

In general, a healthy and balanced diet is recommended during pregnancy.

Signs of early and late miscarriage

Miscarriages within the first 4 weeks often go unnoticed. At this stage, many women don’t yet know they are pregnant. The symptoms of a miscarriage can therefore be confused with those of menstruation. Conversely, experiencing these symptoms doesn’t necessarily mean that a miscarriage will occur.

Typical signs of a miscarriage up to the end of the 12th week of pregnancy include:

• vaginal bleeding
• cramping pain in the lower abdomen
  

Warning signs of miscarriage later in pregnancy include:

• reduced or absent foetal movements
• premature contractions
• discharge of amniotic fluid
• bleeding

Missed miscarriage

A miscarriage without symptoms or bleeding, which usually occurs within the first 12 weeks of pregnancy, is known as a missed miscarriage. It often goes unnoticed by the woman and is identified by a healthcare professional during a routine check-up.

Should bleeding and pain be checked?

During pregnancy, the following symptoms should always be assessed immediately by your gynaecologist:

• bleeding that’s as heavy as or heavier than your menstrual period
• pain in the lower abdomen, back or pelvis
  

Can a miscarriage be prevented?

There’s no guaranteed way to prevent a miscarriage. Certain measures can help reduce the risk, but even when these measures are taken, there’s no absolute protection. Miscarriage is usually not self-inflicted, and women are rarely to blame. What may help:

• Attending scheduled antenatal check-ups
• Eating a healthy and balanced diet
• Avoiding cigarettes, alcohol and drugs
• Gentle physical activity such as long walks, swimming or yoga

Medical treatment after miscarriage

The choice of medical treatment depends on several factors, such as the stage of pregnancy or whether heavy bleeding is present. In some cases, surgery may be required.

Wait and see

With a “wait and see” approach, up to four weeks are given to see whether the pregnancy tissue is expelled naturally. Regular check-ups are carried out. If heavy bleeding or an infection occurs, a gynaecologist should be consulted immediately. Surgical treatment may then be necessary.

Surgery

In surgical treatment, the pregnancy tissue is removed by suction. This procedure is gentle on the uterus and usually performed on an outpatient basis.

Medication

The expulsion of pregnancy tissue can be supported with medication, such as misoprostol. If heavier bleeding occurs, it’s important to seek medical advice immediately.