13 Types of Miscarriage: Understanding the Different Forms

Miscarriages are unfortunate incidents where the foetus is discarded or lost due to medical or genetic reasons. There are different types of miscarriage that occur at different stages of pregnancy, and each one is caused by different factors. Similarly, the symptoms, treatment, and prevention are suggested accordingly. If you are pregnant or planning to get pregnant, it is important that you educate yourself on this issue. This will help you brace yourself in case a miscarriage occurs and understand that there are solutions available. We also answer some commonly asked questions on the topic of miscarriage and its types.

What Is a Miscarriage?

The loss of a foetus during the early stages of pregnancy is known as a miscarriage. Miscarriage is medically termed as spontaneous abortion and typically occurs before the 20^th week of pregnancy (in the first trimester) (1). According to the American Society for Reproductive Medicine and the American College of Obstetricians and Gynecologists, around 15 to 25% of clinically recognised pregnancies terminate in a miscarriage (2) (3). However, a very early miscarriage can also occur before the woman even knows about her pregnancy or before she misses her menstrual period.

Miscarriage has the following symptoms, and it is recommended to contact your gynaecologist if you observe any of the following signs (4):

• Severe abdominal pain
• Cramps
• Gradual progression of vaginal bleeding (from light to heavy)
• Discharge of tissue with clots
• Fever
• Back and lower back pain
• Unexplained weakness

In most cases, miscarriages take place when the foetus has genetic issues. Other causes include medical conditions like diabetes or thyroid disorder in the mother, hormonal issues, uterine abnormalities or infections. There are also some risk factors that can increase your chances of having a miscarriage. These include smoking, excessive caffeine intake, alcohol consumption, and being underweight or obese. Sometimes, couples who indulge in intercourse during the early weeks of pregnancy may experience a miscarriage.

Different Types of Miscarriage

Your doctor will classify your condition after considering your pregnancy stage and the cause of the miscarriage. The different types of miscarriages are as follows (5):

1. Threatened Miscarriage

Threatened miscarriage is a term used to denote vaginal bleeding that happens during the first trimester of a pregnancy where the cervix remains closed. Apart from vaginal bleeding, severe abdominal cramps and lower back pain are notable symptoms of a threatened miscarriage. Your doctor will perform a detailed examination if you have unexplained bleeding. Please note that this does not mean the pregnancy will terminate with a miscarriage (6). As per reports, about half the women who face this risk eventually go on to have a healthy pregnancy.

2. Inevitable Miscarriage

During early pregnancy, if there is heavy vaginal bleeding and severe abdominal (period-like) cramps, it is termed as inevitable miscarriage. However, during this type of miscarriage, as opposed to threatened miscarriage, the cervical canal is dilated. This indicates that the body is getting ready to terminate the pregnancy.

3. Complete Miscarriage

A miscarriage in which all the pregnancy tissue is ejected from the uterus is called a complete miscarriage. Also known as complete abortion, this kind of miscarriage is defined by extreme abdominal pain, heavy vaginal bleeding, and expulsion of pregnancy tissue in its entirety. With this kind of miscarriage, the bleeding and pain subside immediately, although an ultrasound test is recommended to confirm if it is a complete miscarriage.

4. Incomplete Miscarriage

Similar to a complete miscarriage, there is heavy bleeding and severe pain during an incomplete miscarriage. In this type of miscarriage, as well, the cervix is open. However, the pregnancy tissue may not be passed entirely, which can be revealed through an ultrasound.

5. Missed Miscarriage

When a foetus dies quite early during pregnancy, and the tissue continues to remain in the mother’s womb, it is known as a missed miscarriage. The woman may feel all the symptoms of pregnancy if the placenta keeps releasing the essential hormones, but with time, all the signs of pregnancy may gradually decrease. The common symptoms of miscarriage may not be visible in some women while others could be subjected to vaginal discharge and cramping (7).

6. Recurrent Miscarriage

The occurrence of three or more pregnancy losses is defined as recurrent miscarriage (8). Only a small number of women (reports suggest 1-2 %) have repeated miscarriages, in which case it is best to discuss the issue with the doctor or a specialist to take necessary action.

7. Blighted Ovum

In this type of miscarriage, a fertilised egg is attached to the uterine wall but does not develop into an embryo. It is also known as an embryonic pregnancy and occurs early during the pregnancy. During a blighted ovum, the gestational sac remains empty and needs a dilation and curettage procedure (a surgical procedure using an instrument called a curette) to have the uterus scraped.

8. Chemical Miscarriage

Although it sounds ominous, this is a very early miscarriage that usually occurs around the 4^th or 5^th week of pregnancy and happens before the ultrasound scan can detect anything. The sperm fertilises the egg, but the egg is unable to survive any further (9).

9. First-Trimester Miscarriage

A pregnancy loss that happens during the first trimester (first 12 weeks) of pregnancy is a first-trimester miscarriage. Studies show that around 80% of miscarriages happen around the first trimester and can be identified by vaginal bleeding, lower back cramping and loss of pregnancy symptoms.

10. Second Trimester Miscarriage

The second trimester of your pregnancy begins in the 12^th week and ends around the 20^th week. Any miscarriage that occurs during this period can be termed a second-trimester miscarriage. However, this is often unexpected and relatively rare.

11. Ectopic Miscarriage

When the embryo is implanted outside the uterus, an ectopic pregnancy is said to have occurred. Here, the foetus usually does not survive. An ectopic miscarriage is preceded by vaginal bleeding and vomiting, in which case, it is best to see the doctor at the earliest.

12. Molar Pregnancy

When the pregnancy tissue develops into an abnormal growth in the uterus instead of growing into a foetus, a molar pregnancy is said to have taken place. It needs immediate attention, and the next step involves surgical removal of the tissue.

13. Septic Miscarriage (Infection)

A septic miscarriage is a type associated with a uterine infection. Elevated body temperature and abdominal discharge are some probable signs of a septic miscarriage (10).

FAQs

1. Who can get a miscarriage?

A miscarriage can happen to any individual who carries a pregnancy. Approximately 10 to 20% of known pregnancies end in miscarriage (11).

2. What are the causes of a miscarriage?

Hormonal imbalances, lifestyle factors, underlying medical conditions, maternal age, genetic factors, uterine or cervical problems, chromosomal abnormalities, or infections could be the factors behind a miscarriage.

3. Can miscarriage lead to permanent infertility?

A miscarriage does not cause permanent infertility. Women can and have conceived again after a miscarriage. It is best to consult your doctor about your concerns and get a personalised diagnosis to understand your concerns better.

The different forms of miscarriage can occur at different stages of pregnancy and will need expert care and treatment. Coping with it needs one to be emotionally strong, and with support from family and friends, it is possible to tide one over this difficult period. Discuss this with your doctor to understand more about potential health problems that may have led to the miscarriage, and also get guidance on getting pregnant again.

References/Resources:

1. Johns Hopkins Medicine – Miscarriage

2. ASRM – EVALUATION AND TREATMENT OF RECURRENT PREGNANCY LOSS: A COMMITTEE OPINION (2012)

3. ACOG – Early Pregnancy

4. Mayo Clinic – Miscarriage

5. University of Cork, Ireland – Types of Miscarriage

6. Tommy’s – Threatened miscarriage

7. Tommy’s – Missed miscarriage

8. Tommy’s – Recurrent miscarriage

9. Cleveland Clinic – Chemical Pregnancy

10. Miscarriage Australia – Types of miscarriage

11. March of Dimes – Miscarriage

Also Read:

Miscarriage Bleeding
How to Heal From a Miscarriage?
Miscarriage – Types, Causes & Symptoms

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