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If a pregnancy ends before the 24th week, it is known as a miscarriage. Miscarriages are quite common in the first three months of pregnancy and around one in five confirmed pregnancies ends this way. Many early miscarriages (before 14 weeks) happen because there is something wrong with the baby. There can be other causes of miscarriage, such as hormone or blood-clotting problems.

A later miscarriage may be due to an infection, problems in the placenta, or the cervix being weak and opening too early in the pregnancy.

Symptoms
A miscarriage in the first few weeks can start like a period, with spotting or bleeding and mild cramps or backache. The pain and bleeding may get worse and there can be heavy bleeding with blood clots and quite severe cramping pains. With a later miscarriage, you may go through an early labour.

If you bleed or begin to have pains at any stage of pregnancy, contact your doctor or clinic. Find hospital maternity units near you.

If you are more than six or seven weeks pregnant, you may be referred for an ultrasound scan to see if your baby has a heartbeat and is developing normally. Sometimes the bleeding stops by itself and your pregnancy will carry on quite normally. Find out more about bleeding and pain in early pregnancy.

Some women find out that their baby has died only when they have a routine scan. If they have had no pain or bleeding, this can come as a terrible shock, especially if the scan shows that the baby died days or weeks before. This is sometimes called a missed or silent miscarriage.

Some women find out at a routine scan that they have a molar pregnancy, which means the pregnancy has not been successful and a baby will not develop. This is not the same as a miscarriage, and surgery is needed to remove the molar pregnancy.

Treatment for a miscarriage
Sometimes it is preferable to wait and let the miscarriage happen naturally, but there are three ways of actively managing a miscarriage:

• Medicine. You may be offered tablets or pessaries to start the process of miscarriage.
• An operation. If you have been pregnant for less than 14 weeks, your doctor may advise an operation called an ERPC (evacuation of retained products of conception). This will empty your womb (uterus). It is done under anaesthetic. The cervix is gently widened and the contents of your womb are removed by suction.
• Induced labour. If your baby dies after about 14 weeks, you may go into labour. If this doesn't happen, you will be offered tablets that start labour. Although some women would prefer not to go through labour, this is safer for you than an operation to remove the baby. You will be cared for and supported throughout your labour and the birth of your baby.

After a miscarriage
One early miscarriage is unlikely to affect your chances of having a baby in the future. If you have three or more early miscarriages in a row, you should be referred to a specialist for further investigations. However, sometimes no clear cause can be found.

Both women and men find it difficult to come to terms with a miscarriage at any stage. You will almost certainly feel a sense of loss. You'll need time to grieve over the lost baby just as you would over the death of anyone close to you, especially if the miscarriage has happened later in your pregnancy. You may feel shocked, distressed, angry or just numb.

You may feel guilty, wondering whether your miscarriage was caused by anything you did or did not do. It is important to know that, whatever the cause, miscarriage is never anyone's fault. If a miscarriage is going to happen, there is very little that anyone can do to stop it.

Some people find it helps to have something to remember their baby by. In early pregnancy you might be able to have a picture of a scan. If you have a late miscarriage you may be able to see and hold your baby if you wish. You might also be able to take photographs, footprints and handprints as a keepsake. Some hospitals offer parents a certificate to commemorate their baby. This is done because there is no formal registration of a baby who dies before 24 weeks of pregnancy.

Talk about your feelings with your partner and those close to you.