Learning about Pregnancy Loss
This is obviously a very upsetting topic that I wish we didn’t have to discuss but the reality is that miscarriages are quite common so it’s important to learn about (I personally have experienced more than one). If you are experiencing miscarriage, switch to this page to learn about how to manage physically and emotionally.
Types of Pregnancy Loss
Any pregnancy loss before 20 weeks is a miscarriage, afterwards it’s a stillbirth
An ectopic pregnancy is when the embryo implants in the fallopian tubes rather than the uterus - it is a life-threatening situation because as the embryo grows it will cause the tube to burst, so it must be removed surgically
In terms of their estimated frequency:
Miscarriage = 15% of pregnancies
Ectopic = 1% of pregnancies
Stillbirth = 0.5% of pregnancies
Within miscarriage, the majority occur before week 5 and are called “chemical pregnancies”
This is when the loss is so early, it occurs around the same time or just a week after your expected period. This is before it could even be visible on an ultrasound (which is when it moves to becoming a “clinical pregnancy”)
With the invention of modern pregnancy tests, we can confirm that we are pregnant earlier than ever before. But the flipside is that more people will know that they are actually having a miscarriage, whereas before it would have just been considered a late period.
Even today, many people don’t realize they’ve had an early miscarriage, so the miscarriage estimates likely undercount the true number
The miscarriage rate continues to drop off with each week of pregnancy (study)
6 weeks = 10%
7 weeks = 8%
8 weeks =7.5%
9 weeks = 3%
And it continues to go down - fetal loss after the first trimester is probably as low as 1%
Miscarriage risk factors
The two biggest factors that can increase the likelihood of miscarriage are maternal age and history of past miscarriage:
Studies suggest that around age 35, miscarriage risk goes up to 20% and continues to rise. By age 45, it can be as high as 50%. Risks of stillbirth and ectopic pregnancy also rise with age, but the absolute numbers are still very low.
While less studied, there is also evidence to suggest that paternal age over 40 can increase miscarriage risk
While one past miscarriage only increase the likelihood of another slightly, two miscarriages seems to double the risk and three miscarriages increases it by 4x
“Recurrent miscarriage” is the term for the loss of three or more pregnancies consecutively and it is quite rare, only 1% of women
Rates look similar for IVF patients on average though there isn’t clear consensus. On the one hand, the IVF process screens out embryos with genetic issues that might have otherwise resulted in miscarriage. But women undergoing IVF tend to be older and more likely to have a history of fertility challenges
Miscarriage signs
Some women will experience symptoms that they are miscarrying (and then have it confirmed via ultrasound or a blood test revealing decreasing HCG levels) while others will only learn about it through an ultrasound or blood test
Vaginal bleeding is a common symptom of miscarriage. Confusingly, some light spotting early in pregnancy is also normal and is called “implantation bleeding”. Miscarriage-related bleeding is heavier and lasts longer, and is usually accompanied by cramping and nausea/diarrhea.
Lack of nausea during early first trimester is associated with higher risk of miscarriage, but of course lack of nausea can also just be a stroke of luck in a healthy pregnancy, so it’s hard to interpret.
An ultrasound might reveal a miscarriage is occurring due to a slow or non-existent heartbeat, or a yolk sack without an embryo
However, sometimes these signs could just mean the pregnancy isn’t as far along as expected and the dating was just off. This would require doing another ultrasound a week later
