How do you know if you've had a miscarriage?

Still a taboo subject, imbued with fear and, obviously, sadness, miscarriage (which we prefer to call a stopped pregnancy) is intrinsically linked to pregnancy. Because one in ten women worldwide (1) has already been affected, it is time and necessary to speak openly about this sensitive topic. To better cope with it if you are affected (yourself or your loved ones), to recognize it if it happens, to know the steps for your mind and body if you have just experienced one, and above all, to know how to bounce back at your own pace, here are some key points.

 

What is a miscarriage?

A miscarriage is defined as a sudden and involuntary interruption of pregnancy that occurs between 1 and 22 weeks of amenorrhea. However, there are differences in stopped pregnancies, depending on when or how they manifest. It is important to differentiate them well, as the care provided will not be the same and will need to be adapted.

1. Spontaneous miscarriage (abbreviated as FCS in medical terms)

In the case of a spontaneous miscarriage, the embryo is naturally expelled by the uterus.

2. Early miscarriage

An early miscarriage refers to a pregnancy loss that occurs during the first trimester of pregnancy (before the 14th week of amenorrhea).

3. Late miscarriage

Also sometimes called "late abortion", a miscarriage is considered late if it occurs between the third and fifth month of pregnancy (after the 14th week of amenorrhea). A pregnancy loss beyond the first five months (i.e., 22 weeks after the last menstrual period) will be referred to as fetal death.

4. Isolated miscarriage

A miscarriage is qualified as isolated if the pregnant woman has experienced only one, in contrast to recurrent miscarriages (a woman under 40 who has had three consecutive early miscarriages). In the recent 2021 report (1), experts estimate that these recurrent miscarriages are much less frequent: 1.9% of women have two, and this figure even drops to 0.7% for those who have had three. It is important to remember that a miscarriage absolutely does not predict your ability to have a baby later on.

 

How to know if you are having a miscarriage? The signs

When you are pregnant, and perhaps even more so if it's your first pregnancy, it's not always easy to understand your body's signs and pregnancy manifestations during the first few weeks, and to know if and when you should "worry," because everything is changing inside! If you've had a positive pregnancy test and then bleeding appears, it's normal to ask questions and fear a miscarriage. To identify the symptoms of a stopped pregnancy, pay close attention to:

> Sudden disappearance of pregnancy signs you were experiencing (nausea, breast pain, vomiting, etc.)

> Heavy bleeding (often with bright red blood clots)

> Severe pelvic pain (pulling sensations in the back or pelvic area are normal, but if they intensify or persist, it could be a warning sign)

> Contractions (regular and painful) or abdominal cramps

> Fever and chills: check with a healthcare professional to ensure this is not a sign that the gestational sac is expelling the fetus

Some pregnancies can also stop without any particular signs. In case of doubt or anxiety - if you feel that something is not right - consult a doctor, gynecologist or midwife urgently. Sudden blood loss/vaginal bleeding, intense pain (in the lower abdomen, abdomen or back) or loss of consciousness should be immediate warning signs.

How not to confuse miscarriage and periods?

At first glance, it can seem difficult to distinguish an early miscarriage from the main signs of menstruation. Especially during the first months or weeks of pregnancy, when it has not yet been confirmed. Here are some elements to help you differentiate the two:

> Heavy (and long-lasting) bleeding: vaginal bleeding related to a miscarriage is often heavier and more prolonged than usual periods. As a guide, you might need to use more than two sanitary pads per hour. Normal periods, on the other hand, usually require one per hour.

> Presence of blood clots or tissue: during a miscarriage, the expulsion of blood clots or embryonic tissue is often observed. This is not the case during menstruation.

> Blood of a different color: menstrual bleeding often starts with a brownish tint before turning red. Miscarriage bleeding, on the contrary, can be bright red from the start.

> Intense abdominal pain: although menstrual cramps are common during periods, abdominal pain related to a miscarriage is generally more intense. It can even be accompanied by back pain or severe pelvic pain.

> Disappearance of pregnancy symptoms: if bleeding is associated with a sudden disappearance of pregnancy signs (such as nausea, sensitive breasts or fatigue)... This may indicate a miscarriage.

 

What to do in case of miscarriage or doubt

When a miscarriage occurs, a medical consultation can be essential to assess the situation and determine the best course of action. Depending on the stage of pregnancy and how the expulsion takes place, several options are possible:

> Natural expulsion: In cases of early miscarriage, the body can naturally eliminate embryonic tissues. This expulsion is often accompanied by abdominal cramps and bleeding that can last for several days! Medical monitoring is then necessary to ensure that the uterus has completely emptied and that no residual tissue is likely to cause complications.

> Medication: If expulsion does not occur spontaneously, you may be prescribed medication based on misoprostol. This medication triggers contractions and promotes evacuation within 12 to 24 hours. In some cases, a second dose may be prescribed. Doctors tend to prefer this approach for early miscarriages, as it avoids surgical intervention. Once the process is complete, a follow-up ultrasound is performed to check that the uterus is empty.

> Curettage: When the pregnancy is more advanced (generally after 10 weeks of pregnancy) or in case of incomplete miscarriage, surgical treatment becomes necessary. This involves an intra-uterine aspiration performed under local or general anesthesia to remove remaining tissues. The procedure is quick and reduces the risk of infection or hemorrhagic complications.

In short, if in doubt, do not hesitate to ask for help. Consult a doctor, midwife or gynecologist: they will be able to confirm the situation with an ultrasound or a blood test. And if your symptoms become stronger (heavy bleeding, intense pain, fever or malaise), then go to the emergency room without hesitation. This allows for the most appropriate care to be offered to you.

Last important point: after a stopped pregnancy, it is normal to have vaginal bleeding for several days. We strongly recommend that you do not use tampons or a menstrual cup, which could increase the risk of infection.

The same goes for sexual intercourse: it is advisable to wait a few weeks before resuming it.

After a miscarriage: what you need to know

Grieving your perinatal loss

We must not underestimate the trauma that a spontaneous, late, or isolated miscarriage can cause pregnant women. In short, a stopped pregnancy, regardless of the number of weeks at which it occurred. The WHO definition speaks of perinatal grief when parents lose their baby between 22 weeks of amenorrhea and the 7th day after birth, but in all cases, it is a bereavement to be faced by both partners, during which feelings are confused and mixed (emptiness, sadness, disappointment, and sometimes even guilt). Even if the temptation to be alone is strong, it is important to confide in your loved ones, seek psychological support, and talk about it with your partner, who is also suffering and often feels helpless. However, if your grief lasts or paralyzes you for too long, do not hesitate to seek help from a therapist or even join support groups if you feel the need to feel understood. In France, it is estimated that there are 200,000 miscarriages per year (1), so you are not alone. Loved ones can be present, but may not always find the right words or have the necessary empathy if they have not gone through this difficult experience.

 

Requesting sick leave for miscarriage if necessary

According to Ameli, since January 1, 2024, you can obtain sick leave without a waiting period for miscarriage. To benefit from it, it's simple: your doctor can prescribe you paid sick leave from the first day. Please also note that if you prefer your employer not to know the medical reason for your absence, you can request regular sick leave, with a waiting period.

 

Allow yourself time to heal

We often wonder how long a miscarriage lasts. The truth is, there's no exact answer. Because each woman will experience this ordeal differently. But one thing is certain: to recover and be able to consider a new pregnancy as calmly as possible, we obviously believe in the healing power of time. It allows both the body and the heart to recover, little by little, and makes the heavy feeling of guilt after a pregnancy interruption disappear. Even if you are the only one who knows when you will be ready, it is recommended to wait at least a few menstrual cycles before trying to get pregnant again.

But keep confident, because a past stopped pregnancy will not prevent you from having a normal future pregnancy. Remember to check with your gynecologist that menstruation has returned (some women may develop "psychogenic amenorrhea," a psychological blockage of menstruation) after your stopped pregnancy.

 

Prepare for a new pregnancy when you feel ready

Did you know that female fertility increases after a stopped pregnancy? We explain why in our article Why are we more fertile after a miscarriage.

If you are considering a new pregnancy, you need to prepare both your mind and body to experience this joyful event again. While time eventually softens the trauma and removes the fear of it happening again, you can take action in the meantime, by giving your future mom's body a little boost.

To boost your fertility - and at the same time reassure you by regaining confidence in your ability to carry a pregnancy to term - we have created a dietary supplement based on plants and vitamins. By improving ovulation and oocyte quality, rebalancing the cycle and hormones, Baby Boost, our fertility vitamins for women, support all mothers. Those in the making, those who are new to it, those who are at the end of their rope, those who think they can't be, those who are anxious, those who are joyful... Before, during, after, we want to be by your side, in good times and bad.

Finally, if you are pregnant again (congratulations!), do not hesitate to have early follow-up ultrasounds (the first one as soon as possible) to check that everything is going well. And to take care of yourself, of course!

What can be the causes and risks of a miscarriage?

It is legitimate to want to understand what happened and to wonder if you "did something wrong." But this often causes guilt in pregnant women who wrongly feel responsible. Spontaneous pregnancy termination affects about 15% of pregnancies, or 23 million worldwide, and 44 pregnancies lost every minute... (1). It is therefore a phenomenon as unfortunately sad as it is frequent, and whose cause is generally unknown. A mother can be in good health and still experience a stopped pregnancy.

Causes of miscarriage

> Chromosomal abnormalities of the fetus which then fails to develop correctly: this concerns the vast majority of cases. The chromosomes have a problem and/or are not well distributed, or embryonic development (nervous system, heart, etc.) presents dysfunctions. The stopped pregnancy is in this case an appropriate response from the body, which understands that the embryo will not be viable.

> A fall or an accident: a violent shock (or blows) can cause placental abruption.

> An ectopic pregnancy (in the majority of cases).

> Polycystic ovary syndrome (PCOS) which can drastically increase the chances of miscarriage.

> The presence of an infection in the pregnant woman: toxoplasmosis, rubella, listeriosis, etc.

> Maternal health problems: blood clotting problems, hormonal imbalances, uterine fibroids, uterine malformations (such as a septate uterus), or even autoimmune diseases, chronic diseases... In the case of repeated stopped pregnancies, further research is needed to find out if there is a medical cause.

Risk factors

> Age: as with fertility, age unfortunately plays against women in the risk of stopped pregnancy; it would be 12% at age 25, and would increase to 50% at age 42 (2).

> Alcohol or drug consumption during pregnancy (especially heroin, cocaine and amphetamines).

Sources:
https://www.thelancet.com/series/miscarriage
Health Insurance figures