Signs of a miscarriage

Unfortunately not all pregnancies go smoothly. If something goes wrong during the very early stages of the embryo, the pregnancy can sadly end up being a miscarriage. You will usually experience what feels like having your period, along with vaginal bleeding and cramps. Sometimes it will only be discovered during the initial ultrasound scan that there is no heart beat and the cramps and vaginal bleeding occur at a later stage.

A miscarriage is often caused by an abnormality in the embryo. The embryo’s development is affected by the abnormality and is rejected by the uterus. This is most often the result of a chromosomal abnormality which occurs during conception.  It is considered a miscarriage if your pregnancy ends during the first 16 weeks.  Approximately 1 in 10 pregnancies result in a miscarriage.

In the Netherlands 20,000 women every year suffer a miscarriage. The medical term for a miscarriage is ‘spontaneous abortion’.

Can you prevent a miscarriage?

Once a miscarriage happens, you cannot change it. In most cases it cannot be prevented either. Intercourse, cycling, horseback riding or riding a motorbike do not normally cause a miscarriage. Medication, taking extra care during activities, special preventive measures such as bed rest or to stop working are not necessary. You can however make sure your pregnancy gets off to a good start by being aware of various risks during the pregnancy and living as healthy as possible. Obesity and alcohol consumption are risk factors. Certain medication has also been known to cause a miscarriage. Discuss your medication use with your midwife and/or doctor before trying to conceive.

How does a miscarriage begin?

Vaginal blood loss and minor abdominal cramps can be the initial signs of a miscarriage about to occur. But this is not always the case. 1 in 5 women experience vaginal blood loss during the early stages of their pregnancy. Approx. half of these result in a miscarriage. Pregnancy symptoms such as morning sickness and swollen/tender breasts can reduce shortly before a miscarriage occurs.

Once a miscarriage is happening, you can wait or seek treatment at the hospital. Please talk to us about both benefits and disadvantages of these options and consider at home which treatment would suit you best.


Following the initial vaginal blood loss the miscarriage will usually occur within 2 weeks. Sometimes this may take a little while longer. You will begin to experience abdominal cramps much like strong menstrual pains and the vaginal bleeding will increase.  You are ok to use paracetamol against the pain. A miscarriage around 12-16 weeks can bring extra discomfort as the fetus is larger in size. Some women experience blood clots with their bleeding. Once the fetus has been expelled, pain will almost immediately reduce.

The blood loss also reduces quickly and is comparable with bleeding during the last few days from a menstrual period. It is wise not to use tampons because of the risk of infection.

During a miscarriage there is a small chance of severe blood loss. If this happens to you, you must call us immediately. Of course you can always call us if you have any concerns. When the blood loss increases following a miscarriage and the abdominal pain persists, an ultrasound scan will be arranged.  It is possible that pregnancy tissue remains in your uterus. These are then removed. If you decide to wait and let the miscarriage happen naturally, except a small chance of severe blood loss, there is no risk of infection or damage to the uterus and/or cervix. Chances of any future pregnancies are not affected.

Treatment with medication

At the hospital a gynaecologist or midwife can insert tablets into the vagina. This way a spontaneous abortion can be induced. Once the tablets have been inserted you are free to go home.  The miscarriage will occur in the same manner as a spontaneous miscarriage: with abdominal cramps and vaginal bleeding. Inducing a miscarriage with medication does not create risk of infection or damage to the cervix.  There are no risks to any future pregnancies either. Although the medication is not always effective: approximately 50% of the procedures are successful. If the miscarriage does not occur, curettage is sometimes needed as an additional procedure. This carries a minor risk of heavy bleeding.


Curettage is a small surgical procedure where the remaining pregnancy tissue is removed from the lining of the uterus by using a scraping or suction technique. The procedure takes 10 to 15 minutes. You will receive a short term general anaesthetic to prevent any discomfort. In 1 out of 20 women who have undergone curettage, the treatment unfortunately fails and needs to be repeated after 2 weeks. Complications such as infection, heavy blood loss or damage to the cervix can occur. There also exists a small chance that the anaesthetic can cause a problem. Further treatment is required in these cases. There is furthermore a small chance that adhesions can develop on the uterine lining. This may cause difficulty with future pregnancies.

Contact Midwife

If you believe you are experiencing a miscarriage, please contact us. We will discuss with you if an ultrasound is the right way forward. As it is not always the case that vaginal bleeding during pregnancy will result in a miscarriage. It is important to contact us during:

  • Persistent abdominal pain
  • Fever above 38 °C during or following a miscarriage
  • Heavy vaginal bleeding

Emotional Impact

You may experience a difficult time after your miscarriage. As the miscarriage brings a sudden end to your expectations of the future. Especially the first several weeks the sense of grief might very strong. Aside grief other emotions can be felt such as disbelief, anger, a sense of emptiness, failure of your own body, relief or jealousy towards other pregnant women.  These are all common feelings and there is no set time frame for overcoming these feelings. Everyone comes to terms with a miscarriage in their own way, take your time and try to speak to someone about it. Also within a relationship can a miscarriage be experienced differently, give each other the opportunity and space to process. If you believe that after some time you still haven’t regained you normal level of energy or cannot stop worrying, it may be useful to seek professional help in dealing with your miscarriage. For mor information about professional help click here.