Miscarriage and Pregnancy Loss Assessment: Why Does It Happen and Which Tests Are Done?

A pregnancy loss assessment consists of a consultation, an examination and, when needed, tests, done after a pregnancy that has ended by itself in order to understand the cause, to protect your health and to plan the next step. In most losses no cause can be found, and after a single loss a comprehensive investigation is generally not recommended. However early the loss is, the sadness you feel is understandable. The information below offers a general framework and does not replace a diagnosis or treatment recommendation specific to you.

What do miscarriage and pregnancy loss mean?

Miscarriage is an everyday term describing a pregnancy ending by itself in early pregnancy and, less often, in later weeks; in medicine it is called spontaneous pregnancy loss. The term describes only losses that develop by themselves; it does not cover a termination that happens by the person's own decision.

How are losses in early and later weeks told apart?

A loss can happen in a very early stage of pregnancy and is sometimes noticed only on ultrasound or in tests. A loss in later weeks is less common and may need a different approach in the assessment. Which definition applies can vary according to the stage of pregnancy and the classification used; your doctor explains the distinction that fits your situation.

Are stress or sex a proven cause of loss?

Stress and sex are not proven causes. There is no basis for holding yourself responsible for what happened.

What is the most common explanation for early pregnancy loss?

The most common explanation for early losses is problems in the pregnancy's own chromosomes. In many losses, however, no cause can be determined at all; this uncertainty can make it harder to understand what happened.

Which situations can affect the risk of loss?

Maternal age, medical conditions such as diabetes, smoking, heavy alcohol use and being significantly overweight or underweight can raise the risk of loss. The structure of the womb, hormonal factors such as the thyroid, and some autoimmune conditions linked with clotting can also be investigated by the doctor, especially in recurrent losses.

What is assessed in the consultation, examination and ultrasound?

The doctor first listens to what you have been through, your earlier pregnancies and your general health history, then examines you. The ultrasound helps to see whether pregnancy tissue remains in the womb and to monitor the process. If there is pain or bleeding and the location of the pregnancy is uncertain, an ectopic pregnancy is also ruled out.

How are your blood group and blood tests assessed?

Your blood group and Rh status are checked; if you are Rh negative, the doctor assesses whether anti-D is needed. Whether other blood tests will be requested is determined according to your history and findings.

When might the pregnancy tissue be examined?

In some cases the pregnancy tissue obtained during the loss can be sent for examination. The doctor decides in which situation this option will be considered.

How is the loss process managed?

When a loss is detected, the management options are generally waiting, using medicine and a surgical method. A curettage is not needed in every loss; which one is suitable is determined according to your symptoms, the ultrasound findings, your preference and the doctor's assessment. You can ask your doctor for the details of the options and the follow-up plan.

Is a comprehensive investigation needed after a single loss?

Because no cause is found in most losses, a comprehensive investigation is generally not recommended after a single loss. If there is something in your history that needs additional assessment, the doctor handles it separately.

How does the assessment change in recurrent losses or losses in later weeks?

A more comprehensive assessment may be considered in recurrent losses or losses in later weeks. In the definition of recurrent pregnancy loss, guidelines differ from one another on after how many losses this assessment should begin; for this reason you and your doctor decide, based on your own situation, when the investigation should begin. Which tests are done also varies according to the history.

What is expected physically after a loss?

Bleeding and cramping are an expected process in the days after a loss; light spotting and mild cramping are regarded as usual. Talk with your doctor about whether a check-up is needed even after the bleeding has lessened.

Can you get emotional support after a loss?

Pregnancy loss can lead to feelings such as grief, sadness, anger or guilt, even when the loss is early. These feelings occur regardless of how "big" the loss is thought to be. When you need it, you can turn to a health professional or support organisations. Talking with those close to you and telling the doctor following you about your feelings can also be a way of getting support. If intense sadness or hopelessness continues, you can get mental health support.

How can you talk about timing for another pregnancy?

When you are ready to try again varies from person to person; feeling emotionally ready matters as much as physical recovery. You can talk with your doctor about timing, healthy living habits before pregnancy and the need for additional assessment.

What can you ask your doctor?

• Ask what type of loss it was and what was seen on the ultrasound.
• Tell them your blood group and ask whether you need anti-D.
• Find out whether additional tests or examination of the pregnancy tissue are needed at this stage.
• Ask about the expected course of bleeding and cramping, when the check-up is, and which symptoms need you to seek care straight away.
• Talk about the timing of trying again and about contraception.
• Ask which sources you can turn to for emotional support.