The onset of a possible miscarriage is devastating. One minute you’re excitedly dreaming about names and nursery colours, the next you’re heading to the doctor for all the wrong reasons. Miscarriages are common but when the signs first appear they can be confused with other conditions which are not a risk to the pregnancy. The only way to know for certain is to have an ultrasound exam but the following distinctions may help:

1.    The subtle signs

Miscarriage does not necessarily occur immediately after the embryo dies. In fact, a ‘pregnancy’ can continue for several weeks before it’s expelled from the womb. Once the embryo has died, hormone levels begin to drop and you may notice the early signs of pregnancy disappearing eg. nausea and breast tenderness.

2.    Cramping

Cramping is one of the first signs of a miscarriage. Initially this can be confused with the normal discomfort most women experience as the ligaments stretch in the lower abdomen to accommodate the pregnancy. The difference is in the intensity. Miscarriage cramping feels very much like severe period pains, it pulls down in your lower abdomen and it can be more acute to one side. It can also affect your lower back. A miscarriage is painful and the cramping will become increasingly intense. If you are in serious pain rather than slight discomfort it is most likely an impending miscarriage.

3.    Bleeding

Obviously at some point a miscarriage will involve a significant amount of blood loss. It may start off as a brownish colour but it will eventually lead to heavy bleeding involving clots. Many women experience some bleeding during pregnancy, the most common being as a result of implantation bleeding which occurs in the early weeks as the embryo embeds itself in the womb lining. This tends to be light spotting (less than a normal period) and pinkish in colour. Another, less well known, reason for bleeding is a subchorionic haematoma. This is a blood clot that causes part of the placenta to not attach properly to the uterine wall. Whilst the blood loss associated with a subchorionic haematoma can be frightening, it is usually harmless and most women go on to have a successful pregnancy. The key difference between a haematoma and a miscarriage is that a haematoma is painless and does not involve any cramping.

All miscarriages are different but they all involve a combination of both cramping and bleeding together. Some may start with cramping, others with bleeding. The length of time that a miscarriage takes also varies from a few intensely painful hours up to 10 days. Whatever the characteristics it’s important that all women who are miscarrying go for an ultrasound exam to ensure that the womb is emptying all of the contents. Anything left behind can cause an infection and for this reason it is common for D&C (Dilation & Curettage) operations to be performed afterwards.

By Elaine Seager