A miscarriage is the spontaneous loss of a pregnancy before 20 weeks of gestation. It affects an estimated 10% to 20% of known pregnancies, with most occurring in the first trimester. Miscarriages are rarely caused by anything an individual did or did not do. They are typically random events, often due to chromosomal abnormalities.
Understanding Miscarriage Bleeding
Vaginal bleeding is a common miscarriage symptom, and its characteristics vary significantly. It can range from light spotting or brownish discharge to heavy flow with bright red blood and clots. The blood color may also vary, appearing pink, bright red, or dark brown. Bleeding can begin as light spotting and gradually increase in intensity.
The duration of bleeding is also highly variable, typically lasting around two weeks, but it can extend up to a month. The heaviest bleeding often occurs within three to five hours after heavy bleeding begins, with lighter bleeding and spotting potentially continuing for one to two weeks afterward. Miscarriage bleeding frequently includes blood clots, which can range in size from a dime to a lemon. You may also notice the passage of tissue, which can appear as gray-white material, a fluid-filled sac, or other products of conception, especially in later miscarriages.
Recognizing Concerning Bleeding
While bleeding is expected during a miscarriage, certain signs indicate that the blood loss might be too much and warrants immediate medical attention. One significant indicator is soaking through more than two sanitary pads per hour for several consecutive hours. Another concerning sign is passing blood clots that are larger than a golf ball or a lemon. These quantities suggest a heavier-than-normal blood loss that could lead to complications.
A foul-smelling vaginal discharge, particularly when combined with persistent or heavy bleeding, can be a sign of infection. Additionally, a sudden and significant increase in the amount of bleeding or a change to an unusually strong odor should prompt medical consultation.
Seeking Immediate Medical Help
Beyond the amount of bleeding, other symptoms, when present with vaginal bleeding, signal a need for immediate medical evaluation. Severe abdominal pain or cramping, especially if it is worse than typical menstrual cramps and not relieved by over-the-counter pain medication, should be reported to a healthcare provider. This pain can sometimes feel similar to labor contractions. Dizziness, lightheadedness, or fainting are serious symptoms that may indicate significant blood loss and require prompt medical attention.
A fever higher than 100.4°F (38°C) or chills, particularly if they persist, could signify a uterine infection. A gush of fluid from the vagina, even without pain or bleeding, or the passage of tissue, also warrant contacting a healthcare professional.
Medical Evaluation and Support
Following a suspected miscarriage, a medical evaluation typically involves several steps to confirm the pregnancy loss and determine the best course of action. Healthcare providers often perform an ultrasound to check for a fetal heartbeat, assess the pregnancy’s development, and confirm if any tissue remains in the uterus. Blood tests may also be conducted to measure levels of human chorionic gonadotropin (hCG), a pregnancy hormone, and to check blood type. If the hCG levels are low or falling, it can confirm a miscarriage.
Management options for miscarriage vary based on individual circumstances and may include expectant management, medical management, or surgical procedures. Expectant management involves waiting for the pregnancy tissue to pass naturally, which can take days to weeks. Medical management uses medication, such as misoprostol, to help the uterus expel the tissue. Surgical options, like dilation and curettage (D&C) or aspiration, remove any remaining tissue, which may be recommended for heavy bleeding, infection, or if other methods are unsuccessful. Emotional support and resources are available to help individuals navigate the grieving process.