Recurrent Miscarriage

If you have two or more miscarriages in a row, it's called recurrent miscarriage.

While miscarriage is very common, recurrent miscarriage occurs in only about 1% of pregnancies. If you have recurrent miscarriage, you may still be able to maintain a healthy pregnancy in the future.

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On this page  

• What Is Recurrent Miscarriage?
• What Are the Symptoms of Recurrent Miscarriage?  
• How Do You Diagnose Recurrent Miscarriage?
• How Do You Treat Recurrent Miscarriage?

What Is Recurrent Miscarriage?

Doctors define recurrent miscarriage as a condition in which someone has two or more miscarriages in a row. Recurrent miscarriage is also known as recurrent pregnancy loss (RPL).

A miscarriage is the loss of a pregnancy during the first 20 weeks. Most miscarriages occur because the fertilized egg in the uterus doesn't develop normally.

The risk of miscarriage is lower after the first 12 weeks of pregnancy. Pregnancy loss after 20 weeks of gestation is considered a stillbirth. 

It's still possible to have a healthy pregnancy even after recurrent miscarriage. But if you’ve had multiple miscarriages, you should talk to your doctor about future pregnancy plans. They may refer you to a maternal-fetal specialist who specializes in high-risk pregnancy and recurrent loss.

How common is recurrent miscarriage?

Although miscarriages are very common, with an estimated 10% to 30% of pregnancies ending in miscarriage, recurrent miscarriage only occurs in 0.5% to 1% of pregnancies.

About 80% of miscarriages occur in the first trimester (before the 12th week of pregnancy) — many before people know they're expecting. Miscarriage in the second trimester (between 13 and 19 weeks of pregnancy) occurs in 1% to 5% of pregnancies. 

Types of recurrent miscarriage

Recurrent miscarriage is classified into two types:

• Primary — Recurrent miscarriage that occurs in a person who has never given birth to a live baby.
• Secondary — Recurrent miscarriage that occurs in a person who has previously given birth to a live baby.

Miscarriages are further classified by their symptoms and conditions:

• Asymptomatic miscarriage — When you don’t experience bleeding, cramping, or passing tissue from pregnancy out of your body. The tissue may pass spontaneously later on, like a menstrual period, or you may need a procedure to remove the tissue from your uterus and cervix. Also called an empty sac pregnancy.
• Complete miscarriage — When your body passes all of the tissue from pregnancy during a miscarriage. Tissue may be passed suddenly or after having treatment for the miscarriage.
• Incomplete miscarriage — When your body doesn't pass all of the tissue from pregnancy during a miscarriage. A person with an incomplete miscarriage may have cramping or bleeding.
• Threatened miscarriage — When a pregnant person presents signs of potential miscarriage before 20 weeks of pregnancy. They may have vaginal bleeding, little or no pain, an undilated cervix, and the presence of a fetal heartbeat. While a threatened miscarriage suggests that a miscarriage might occur, it may not. The pregnancy will often continue.

What causes recurrent miscarriage?

Only about 50% of instances of recurrent miscarriage have a known cause.

It may help to know that most miscarriages happen because the fertilized egg in the uterus doesn't develop normally, not because of something you did. A miscarriage isn't caused by stress, exercise, or sex. Often, doctors don't know the cause.

There are many possible causes for recurrent miscarriage, including:

• Abnormalities in the uterus, such as fibroids, polyps, and uterine septum.
• Abnormal number of chromosomes in the embryo. An estimated nearly 70% of miscarriages occur because of chromosomal abnormalities in the embryo. 
• Antiphospholipid syndrome, which causes blood clotting problems during pregnancy.
• Blood disorder or abnormal blood clots.
• Celiac disease.
• Cervical insufficiency or incompetent cervix, when your cervix dilates (opens) too early in pregnancy.
• Chromosome translocation, when one part of a chromosome moves to another chromosome.
• Chronic uterine infections.
• Chronic health conditions, such as high blood pressure, thyroid disease, or kidney disease.
• Genetic abnormalities.
• Hormonal and metabolic concerns, such as undiagnosed thyroid diseases or unstable diabetes.
• Infections, such as parvovirus B19, cytomegalovirus, sexually transmitted infections (STIs), and listeriosis.
• Placental abruption.
• Polycystic ovary syndrome (PCOS), which causes an imbalance in reproductive hormones.
• Premature rupture of the membranes (PROM), when your water breaks too early.
• Preterm labor.
• Uterine scar tissue, often the result of uterine surgeries or previous pelvic infections. Also called Asherman syndrome.

Recurrent miscarriage risk factors and complications

Recurrent miscarriage risk factors

You may be at increased risk of having recurrent miscarriage if you:

• Are 35 or older.
• Are obese.
• Are of a low socioeconomic status, homeless, food insecure, or at an increased risk of being a victim of violence.
• Are severely malnourished or underweight.
• Became pregnant while using an intrauterine device (IUD) for birth control.
• Became pregnant with an assigned male at birth (AMAB) partner who is over 35 years old.
• Consume large amounts of caffeine while pregnant.
• Experience intense stress.
• Have a blood-clotting disorder, such as antiphospholipid antibody syndrome, or autoimmune disorders.
• Have a personal history of miscarriages (two or more).
• Have been exposed to dangerous chemicals.
• Have certain bacterial or viral infections during pregnancy, including Group B beta strep infection.
• Have congenital heart disease or severe kidney disease.
• Have hormone problems, such as polycystic ovary syndrome (PCOS) and luteal phase defect. 
• Have pre-existing diabetes or hypertension.
• Have problems with the structure of your uterus, such as a uterus with a septum or wall.
• Have undergone certain prenatal tests, such as amniocentesis or chorionic villus sampling.
• Have taken certain medications, especially nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen, naproxen, and diclofenac, or the acne medication isotretinoin.
• Have thyroid problems.
• Sustain a forceful injury to your belly, such as from falling, domestic violence, or being in a car accident.
• Use alcohol, cigarettes, or cocaine while pregnant.

Recurrent miscarriage complications

In rare cases, miscarriage can cause health problems, like infection or too much bleeding. Seek emergency care if you have any signs of miscarriage complications.

These include:

• Chills.
• Fever — Temperature above 100.4 (F).
• Heavy bleeding — Soaking through two large pads in one hour, for two or more hours.
• Severe pain — That doesn’t go away despite over-the-counter (OTC) pain relievers.

Recurrent miscarriage also has a tremendous impact on your emotional and mental health. You may experience intense feelings of sadness, anxiety, low self-esteem, confusion, frustration, hopelessness, or fear about future pregnancies. 

Recurrent miscarriage can also create relationship and intimacy problems for a couple. If you and your partner are experiencing negative psychological and emotional effects of recurrent miscarriage, you should speak to your doctor, a support group, or a licensed counselor.

How can I prevent recurrent miscarriage?

Miscarriage is usually a chance event, and there's nothing you can do to prevent it.

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What Are the Signs and Symptoms of Recurrent Miscarriage?

Having two or more miscarriages in a row is indicative of recurrent miscarriage. A miscarriage is often a chain of events that can occur over several days.

Symptoms of a miscarriage include:

• Cramps that are more intense than menstrual cramps.
• Decreased movement of your baby.
• Dilated cervix.
• Not feeling pregnant anymore. Your breasts may feel less tender, you may urinate less frequently, and you may have less nausea or vomiting.
• Passing blood clots, grayish tissue, or a fluid-filled sac from the vagina.
• Vaginal bleeding with pain, pelvic cramps, or a persistent, dull lower back ache. Bleeding may be light or heavy and constant or off-and-on. Accompanying pain may occur a few days after bleeding starts.

The experience of miscarriage varies widely from person to person. Some people may experience no signs of a miscarriage and only learn that they miscarried during a routine ultrasound.

Having signs of a miscarriage doesn't mean that you're definitely having a miscarriage, though. Pregnancy symptoms can vary and fluctuate greatly. About half of people who experience vaginal bleeding early in pregnancy still go on to have a normal pregnancy and birth. 

Self-care when you're having a miscarriage

If you're having a miscarriage, here are some tips:

• Eat a balanced diet high in iron and vitamin C because you may be low in iron from blood loss. Foods rich in iron include red meat, shellfish, eggs, beans, and leafy green vegetables; foods high in vitamin C include citrus fruit, tomatoes, and broccoli. Your doctor may recommend that you take iron pills or a multivitamin.
• Take ibuprofen (Advil or Motrin) or acetaminophen (Tylenol) for cramps.
• Get support from your family, friends, or a counselor to help navigate the loss of your pregnancy. If you're feeling very sad or depressed for more than a couple of weeks, you should talk to your counselor or doctor right away.
• Talk with your doctor if you have plans for future pregnancy. If you don’t want to get pregnant again, talk to your doctor about birth control options.
• Use sanitary pads until the bleeding stops. It’s normal to have mild to moderate vaginal bleeding for one to two weeks, and using pads can make it easier to monitor your bleeding. It may be similar to or slightly heavier than a normal period, but it should get lighter after a week. Your period should resume three to six weeks later.

When should I see a doctor about my recurrent miscarriage symptoms?

You should go to the emergency department if you have heavy bleeding (soaking through two large pads in one hour) that lasts two hours or more, and if you have lightheadedness or a fever in addition to symptoms of miscarriage.

Bleeding and cramping may also be a sign of an ectopic pregnancy, which can be life-threatening and requires medical care.

Some people may want to ignore signs of miscarriage to avoid the uncomfortable feelings of fear and grief that often accompany a pregnancy loss. But it's very important that you don't delay medical treatment for a miscarriage. If left untreated, miscarriage can result in serious health problems.

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How Do You Diagnose Recurrent Miscarriage?

If you suspect you've had or may be having a miscarriage, your doctor will ask you about the start, frequency, and severity of your symptoms. They may want you to come in for a physical exam so they can look at your cervix to see if it’s dilated, a sign of miscarriage.

If you have recurrent miscarriage, your doctor will want to know the fetal gestational age in your prior losses, as recurrent miscarriage tends to occur at a similar gestational age in future pregnancies. They'll also want to know any previous treatment of prior miscarriages, as certain treatments can increase your risk of recurrent miscarriage. 

Tests to diagnose miscarriage

Often miscarriages happen for no apparent reason. But your doctor can run advanced tests and look for clues and possible causes.

If you have two or more miscarriages in a row, your doctor may:

• Biopsy endometrial (uterine lining) tissue.
• Check for genetic problems.
• Order chromosome tests of you and your partner. This may include karyotyping, in which your chromosomes are counted and observed to look for changes.
• Do a chromosome test of tissue from miscarriage, if available, to check for chromosomal conditions.
• Conduct a hysteroscopy or pelvic ultrasound to check for problems with the structure of the uterus.
• Test hormone levels. Your doctor will look for the presence of human chorionic gonadotropin hormone (hCG), also called the “pregnancy hormone.” This test will be repeated for two to three days to confirm a miscarriage. If the level drops or rises too slowly, a miscarriage is likely.
• Test your blood for antibodies or autoimmune disorders, such as lupus or antiphospholipid antibody syndrome (APS).
• Use ultrasound to see if the fetal heart has stopped or to look at your uterus.

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How Do You Treat Recurrent Miscarriage?

There's no treatment to stop a miscarriage. If your doctor confirms that you're having a miscarriage, treatment options will depend on your stage of pregnancy and current health.

These options can include:

• Waiting for the miscarriage to happen naturally — If you don't have heavy blood loss or signs of infection (such as fever or weakness), you can choose to let the miscarriage follow its natural course. It can take days or more than a week for all the tissue to pass through the vagina. This period of waiting is called expectant management, and it allows your doctor to watch for and treat any complications that may arise from the miscarriage.
• Taking medication to speed up the process — Medications such as mifepristone and misoprostol help the tissue pass. These drugs can help to reduce bleeding after a miscarriage and ensure the miscarriage is over within 48 hours. While medication gives you more control over timing, it can increase cramping and may upset your stomach. 
• Having surgery — Surgical treatment of miscarriage involves surgical abortion and is the quickest option to treat a miscarriage. This is done through a dilation and curettage (D&C) procedure, in which a small surgical instrument called a curettage is used to remove tissue from your uterus and/or a dilation and evacuation (D&E) to clear the uterus through suction. This may be the best option for you if you have heavy bleeding, certain health conditions (like a bleeding disorder), or if some tissue remains in the uterus.

If you're bleeding heavily as a result of a miscarriage, you'll need to be tested for anemia.

Regardless of the treatment choice that you make for a miscarriage, it's important to see your doctor for a follow-up appointment. They'll want to ensure that you're healing well physically and emotionally.

Managing recurrent miscarriage

Managing recurrent miscarriages in an effort to carry a future pregnancy to term focuses on treating the specific cause of the recurrent miscarriages. However, 50% of couples will have no identifiable cause for their multiple losses despite thorough evaluation.

If an underlying health problem or genetic disorder may be the cause of your recurrent miscarriages, identifying and treating any underlying health problems or genetic disorders may help to prevent future losses.

If your doctor suspects that your recurrent miscarriage may be the result of scar tissue in your uterus due to previous uterine surgeries or pelvic infections, they may surgically remove the scar tissue to reduce your risk of miscarriage.

If you have cervical insufficiency or incompetent cervix, in which your cervix dilates too early, your doctor may recommend that you have a cerclage, which is a stitch put in your cervix to help to keep it closed.

Your doctor may want to test your blood to see if you have an Rh-negative blood type. This can present health risks to you and your baby if the baby in a future pregnancy has an Rh-positive blood type. If you do have negative Rh-blood, your doctor may recommend that you get a shot of Rh immunoglobulin to help to prevent future pregnancy problems. 

How do you cope with recurrent miscarriage?

It can be very difficult to have a pregnancy loss. It’s normal to wonder if you did something wrong to cause a miscarriage. However, it’s important to understand that pregnancy loss is almost always out of your control — you didn’t cause it, and you couldn’t have prevented it.

It can take up to a month or more for your body to recover from a miscarriage. You may still have pregnancy hormones in your body for one to two months after a miscarriage. But it can take even longer for you or your partner to recover emotionally. 

Pregnancy loss is just that — a loss. It's common and normal to go through a grieving process following a miscarriage, regardless of the length of your pregnancy. The length and intensity of the grieving process varies from person to person. It's important to allow yourself the time and space to grieve, process, and heal following a miscarriage or recurrent miscarriage. 

Many people struggle with a range of emotions following miscarriage, including feelings of depression, anxiety, grief, anger, or worry. Some people may even feel a sense of relief if they didn’t want to be pregnant, which can be confusing or cause a person to feel guilt. 

Due to the hormonal swings caused by pregnancy, these feelings may fluctuate in frequency and severity. If you have feelings of profound sadness or hopelessness or experience a lack of interest in daily activities for more than a couple of weeks, you should call your doctor right away.

To cope with your loss, consider meeting with a support group, reading about the experiences of others, and talking to friends, a licensed therapist, or a member of the clergy. You can also find pregnancy loss resources in your area at SHARE: Pregnancy and Infant Loss Support.

Can you try to get pregnant again after recurrent miscarriage?

A healthy pregnancy following a miscarriage is possible. But if you have recurrent miscarriage, your doctor may advise you to wait until any testing and treatment are complete before trying to get pregnant again. It can also take time for your body to recover and your uterine lining to prepare for another pregnancy. 

It's beneficial to wait to try to get pregnant again until you have had at least one period after a miscarriage. It’s important that you feel emotionally and physically ready for pregnancy. 

If you're ready to become pregnant again, you should schedule a prenatal checkup with your ob-gyn. They can do a complete physical exam to make sure that your body is as healthy as possible before you conceive. 

You can also make lifestyle changes that support a healthy pregnancy, such as:

• Don’t drink alcohol.
• Don’t smoke.
• Don’t use street drugs.
• Eat a healthy and balanced diet.
• Get at least 30 minutes of physical activity most days.
• Limit caffeine consumption to about one cup of coffee per day.
• Maintain a healthy weight.
• Manage any underlying health conditions, such as high blood pressure or diabetes.
• Take a prenatal vitamin with at least 400 mcg of folic acid daily.

If you do become pregnant after recurrent miscarriage, your doctor may recommend more frequent monitoring or ultrasounds of your pregnancy to ensure that you and your baby are healthy. 

Some people may have mixed feelings after they give birth following recurrent miscarriage. Sometimes memories of your previous losses may resurface, causing grief and joy at the same time. Many people find it helpful to work with a therapist before, during, and after pregnancy to navigate these complicated feelings.

It is also OK if you don’t want to try, or you want to wait to try to get pregnant again. The important thing is that you do what’s right for you and take the time you need to process your pregnancy loss.

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Last reviewed by a UPMC medical professional on 2024-09-05.