Terminology

There are many different terms to describe pregnancy loss. The most important ones to be aware of are :

​

Early Pregnancy Loss : Pregnancy loss under 20 weeks

Stillbirth : Pregnancy loss over 20 weeks gestation

Recurrent Pregnancy Loss : 2-3 pregnancy losses

​

Other terms used include :

​

Anembryonic Pregnancy/Blighted Ovum : gestational sac seen on ultrasound, but no yolk sac and/or embryo visible

Embryonic Demise : embryo measuring over 7mm without cardiac activity

Miscarriage : synonymous with pregnancy loss

Biochemical Pregnancy Loss : pregnancy loss prior to visualization of pregnancy structures on ultrasound

Second-trimester Pregnancy Loss : pregnancy loss occurring between 13+0 weeks and 20+0 weeks gestation

Missed Abortion : pregnancy loss without any symptoms

First-trimester pregnancy loss occurs in up to 30% of pregnancies overall, and up to 10% of clinically recognized pregnancies. If a pregnancy is visualized on ultrasound and a heartbeat is present, the occurrence of miscarriage is 3-5%. The incidence of pregnancy loss greatly varies with female age. Below the age of 30, pregnancy loss ranges from 7-15%. Pregnancy loss begins to rise for females aged 30-34 (8-21%), females 35-39 (17-28%) and is highest for females aged 40 and above (34-52%)​

Second-trimester pregnancy loss occurs in less than 1% of pregnancies.

First-trimester Pregnancy Loss

Chromosomal abnormalities account for 50-70% of first-trimester pregnancy loss. Increasing female age is an important cause of chromosomal abnormalities. Other causes include maternal medical conditions (i.e. endocrinopathies, cardiovascular disease, and metabolic disorders), infection, diabetes, elevated BMI, thyroid disease, long-term stressors, inherited thromobophilias, presence of an IUD, medications, substance use, environmental factors, trauma, race/ethnicity and paternal medical conditions (i.e. metabolic conditions).

​

Second-Trimester Pregnancy Loss

Second-trimester loss is much less common. Specific factors that may contribute include infection, chronic stressors, uterine malformations, cervical insufficiency, fetal malformations, thrombophilias, abruption, preterm prelabor rupture of membranes, and preterm labour.

Pregnancy loss may be completely asymptomatic or present with cramping and/or bleeding. Bleeding and/or cramping occurs in up to 20-40% of normal (viable) pregnancies. If you are having bleeding and/or cramping, contact your healthcare provider for consideration of investigations such as bloodwork and/or an ultrasound if appropriate. Read more here.

​

Most early pregnancy losses can be managed at home. You should go to an emergency department if you have severe pain that is not relieved by Tylenol/Advil, feel faint, and/or have heavy bleeding (soaking a pad within an hour for 2-3 hours).

Stillbirth is much less common. In general - this is a loss occurring over 20 weeks gestation. It can be a result of maternal, fetal or placental factors. Read more here.

Depending on the gestational age of the loss, the options may include :

• Expectant Management

• Medical Management (usually Mifepristone + Misoprostol)

• Surgical Management (Dilatation + Curettage/Evacuation)

Your care provider may recommend a specific option depending on your clinical situation. Read more here: PregnancyED

Pregnancy termination for any reason is legal in Canada. Speak to your healthcare provider about options. You can also find more resources and a confidential phone line here.