Pregnancy Loss: Causes, Essential Evaluations, and the Chance of a Healthy Pregnancy

Introduction

A positive pregnancy test is usually accompanied by hope, planning, and the formation of an image of the future. For this reason, the end of a pregnancy at any stage can be a deeply painful experience, even when the pregnancy was still in its earliest weeks or when other people did not yet know about it.

Pregnancy loss is relatively common, but its frequency does not reduce the intensity of a person’s grief, anxiety, or sense of loneliness. Some people blame themselves and believe that everyday activities, a particular food, sexual intercourse, travel, exercise, or a stressful moment caused the loss. In most cases, these assumptions are not correct.

Many pregnancy losses occur because of factors that are beyond the parents’ control. Experiencing one, or even more than one, pregnancy loss also does not necessarily mean that a person will be unable to have a healthy child.

A careful evaluation can identify treatable factors and help prevent unnecessary tests or treatments.

What Does Pregnancy Loss Mean?

Terminology and gestational age limits differ between countries and clinical guidelines.

In general, the spontaneous ending of a pregnancy before the fetus reaches the stage of viability is considered an early pregnancy loss.

The World Health Organization notes in its public resources that definitions are not the same across countries. WHO commonly classifies fetal death before 28 weeks as miscarriage and fetal death from 28 weeks onward as stillbirth.

However, many healthcare systems use earlier gestational age limits when making clinical decisions.

For the patient, receiving a clear diagnosis, safe care, and respectful support is more important than the terminology used.

What Is a Chemical Pregnancy?

A chemical pregnancy occurs when a pregnancy test becomes positive because the level of the hormone hCG has increased, but the pregnancy ends before it can be clearly seen on ultrasound.

It may appear only as a period that is delayed for several days followed by bleeding. As home pregnancy tests have become more sensitive, chemical pregnancies are now detected more often than in the past.

From an emotional perspective, the early stage of the pregnancy does not make the loss unimportant. The person may still need psychological support and time to grieve.

Possible Symptoms

Symptoms may include:

• Bleeding or spotting
• Cramping or lower abdominal pain
• Passing blood clots or tissue
• A decrease in some pregnancy symptoms
• Back pain
• Ultrasound findings showing that development has stopped or that no heartbeat is present

Spotting does not always mean that a pregnancy is ending. Some women experience spotting during a healthy pregnancy.

In contrast, sometimes the pregnancy has stopped developing but bleeding has not yet begun. This may be detected during an ultrasound examination.

Any bleeding during pregnancy should be evaluated according to the gestational age, the amount of bleeding, the presence of pain, and the person’s overall condition.

Which Symptoms Require Immediate Medical Attention?

Immediate medical care is needed in the following situations:

• Heavy bleeding, such as pads becoming soaked quickly
• Severe or one-sided abdominal or pelvic pain
• Shoulder pain
• Dizziness, severe weakness, or fainting
• Fever, chills, or foul-smelling vaginal discharge
• Severe heart palpitations or shortness of breath
• Pain with a positive pregnancy test, particularly when the location of the pregnancy has not yet been confirmed

These symptoms may be associated with significant bleeding, infection, or an ectopic pregnancy.

An ectopic pregnancy can be life-threatening and should not be managed at home as though it were an uncomplicated pregnancy loss.

Common Causes of Pregnancy Loss

1. Chromosomal Abnormalities in the Embryo or Fetus

A significant proportion of early pregnancy losses occur because the embryo or fetus has an abnormal number or structure of chromosomes.

This abnormality usually develops during the division of the egg, sperm, or the earliest embryonic cells and is often a random event.

In these circumstances, the body stops the pregnancy because the embryo cannot develop normally.

This is generally not the result of something the mother or father did.

The risk of chromosomal abnormalities increases as the egg ages, but these abnormalities can occur at any age.

2. Maternal Age

As age increases, particularly after the age of 35, the chance of creating an embryo with an abnormal number of chromosomes also increases.

This may raise the likelihood of difficulty becoming pregnant and early pregnancy loss.

Age is a risk factor, not a definite prediction. Many women over the age of 35 have healthy pregnancies.

3. Parental Genetic Factors

In a small number of couples, one parent has a balanced chromosomal translocation or another structural chromosomal change.

The person is usually healthy, but some of their eggs or sperm may contain an unbalanced chromosomal combination.

In selected circumstances, karyotype testing and genetic counselling may be recommended.

The presence of a chromosomal change does not mean that having a healthy pregnancy is impossible.

4. Structural Problems of the Uterus

Certain congenital or acquired uterine abnormalities may be associated with pregnancy loss, including:

• A uterine septum
• Certain fibroids that distort the uterine cavity
• Intrauterine adhesions
• Large polyps in particular locations
• Certain abnormalities in the shape of the uterus

Not all fibroids or differences in uterine structure require surgery.

Their significance depends on their location, size, and effect on the uterine cavity.

5. Antiphospholipid Syndrome

Antiphospholipid syndrome is an autoimmune disorder that can increase the risk of blood clots and pregnancy complications.

Diagnosis requires both appropriate clinical findings and specific blood tests performed at the correct intervals.

When the diagnosis is confirmed, medically supervised treatment may improve pregnancy outcomes.

Self-treatment with aspirin or anticoagulant medication is not recommended. These medicines are not appropriate for everyone and may cause bleeding.

6. Thyroid Disorders and Diabetes

Uncontrolled underactive or overactive thyroid disease and uncontrolled diabetes may be associated with a higher risk of pregnancy complications.

The goal is to diagnose and manage these conditions according to accepted medical standards.

Taking thyroid medication, iodine supplements, or glucose-lowering medicines without medical supervision can be dangerous.

7. Infections

Certain infections can cause pregnancy complications. However, performing a broad panel of infection tests for everyone who has experienced a pregnancy loss is not always useful.

Testing should be based on symptoms, medical history, physical examination, and individual risk factors.

Treating an infection without a valid diagnosis may also lead to unnecessary antibiotic use.

8. Sperm-Related Factors

Fertility is not solely related to the woman.

Paternal age, certain illnesses, tobacco use, extreme heat exposure, recreational drugs, and sperm abnormalities may affect male reproductive health.

In selected circumstances, sperm DNA damage may be investigated as a possible factor.

However, sperm DNA fragmentation testing is not necessary for every couple or after every pregnancy loss. A specialist should make this decision based on the medical history and other test results.

Does Stress Cause Pregnancy Loss?

Everyday stress, worry, sadness, or an emotional disagreement is not usually a direct cause of pregnancy loss.

Blaming the loss on the mother’s emotions may increase her sense of guilt.

Severe and chronic stress can affect sleep, nutrition, mental health, and health-related behaviours, which is why psychological support is important.

However, a person should not be told that she lost her pregnancy because she was not calm enough.

Are Exercise, Sexual Intercourse, or Working Responsible?

In an uncomplicated pregnancy, normal daily activity, walking, suitable exercise, and sexual intercourse do not usually cause pregnancy loss.

In specific situations, such as bleeding, placenta previa, cervical insufficiency, or certain pregnancy complications, a doctor may recommend temporary restrictions.

These decisions should be individualised.

Strict bed rest has also not been shown to prevent early pregnancy loss in everyone and may increase the risk of blood clots, muscle weakness, and psychological difficulties.

After How Many Losses Should a Specialist Evaluation Begin?

The appropriate time to begin an evaluation depends on age, medical history, the gestational age at which the loss occurred, underlying conditions, and the guideline being followed.

In many newer approaches, a specialist evaluation may be considered after two clinically recognised pregnancy losses, particularly when they occur consecutively.

Not everyone needs to wait until the loss happens additional times.

Earlier evaluation may be especially important in the following circumstances:

• Higher maternal age
• A history of ectopic pregnancy
• An autoimmune condition or history of blood clots
• A known uterine abnormality
• A history of cancer treatment
• Pregnancy loss during the second trimester
• Fetal death at a later stage of pregnancy
• A family history of a genetic disorder
• A prolonged period of difficulty becoming pregnant

Which Evaluations May Be Necessary?

Testing should be targeted and may include:

• A complete medical history for both partners
• Review of previous pregnancy records and ultrasound or pathology reports
• Physical examination
• Assessment of uterine structure using ultrasound
• In selected circumstances, three-dimensional ultrasound, saline infusion sonography, or hysteroscopy
• Thyroid function tests
• Diabetes assessment based on risk factors
• Tests for antiphospholipid syndrome
• Parental genetic testing in selected circumstances
• Genetic testing of pregnancy tissue when possible and medically indicated
• Semen analysis and assessment of male reproductive health
• Ovarian reserve assessment when there are fertility concerns

Not every immune, clotting, hormonal, or genetic test promoted commercially is necessary for every person.

Tests without adequate evidence may lead to unnecessary expense, anxiety, and treatment.

Management Options After the Diagnosis

If a pregnancy is no longer developing, there are three main management approaches, depending on the person’s condition.

Expectant Management

In some cases, it is possible to wait for the body to pass the pregnancy tissue naturally.

The patient should receive clear guidance about the expected amount of bleeding and pain and about warning signs that require medical attention.

Medical Management

Medication may be used to help the uterus empty.

The type of medicine and instructions for its use should be determined by a doctor.

Surgical Management

Surgical evacuation of the uterus may be performed in cases of heavy bleeding, infection, clinical instability, retained tissue, or the patient’s informed preference.

No single option is appropriate for everyone.

The person should receive clear information about the benefits, limitations, expected level of pain, likely duration, and the possibility that another intervention may later be required.

When Is It Possible to Try for Pregnancy Again?

After a pregnancy loss, the appropriate time to try again depends on physical recovery, the end of bleeding, the results of any evaluation, and the couple’s emotional readiness.

In many uncomplicated cases, there is no medical reason to wait for a long period.

However, after an ectopic pregnancy, infection, surgery, the use of certain medications, or particular complications, a doctor may recommend waiting for a specific period.

Emotional readiness is also important.

Some people feel ready sooner, while others need more time. There is no single correct or incorrect response.

Are IVF or Embryo Genetic Testing Necessary?

IVF is not an automatic treatment for everyone who has experienced pregnancy loss.

Even when age or a genetic factor is involved, the decision to use IVF and preimplantation genetic testing should be based on the couple’s circumstances, the expected number of embryos, cost, limitations, and probability of success.

Embryo genetic testing cannot eliminate every cause of pregnancy loss and does not guarantee the birth of a healthy baby.

Care Before the Next Pregnancy

Before trying again, the following measures may be considered:

• Reviewing current medications
• Taking folic acid according to medical advice
• Managing thyroid disease, diabetes, and high blood pressure
• Stopping cigarette smoking, shisha use, and recreational drugs
• Avoiding alcohol
• Gradually reaching a healthy weight
• Getting sufficient sleep and appropriate physical activity
• Reviewing vaccination status
• Receiving genetic counselling when needed
• Planning an early medical appointment in the next pregnancy

No supplement or diet can guarantee a healthy pregnancy.

Psychological Support Is Part of Treatment

The World Health Organization emphasises that pregnancy loss is often surrounded by silence, shame, and social stigma.

A person may experience grief, anger, anxiety, insomnia, jealousy, fear of another pregnancy, or guilt.

Partners and family members should respect the person’s experience rather than using phrases such as “You can become pregnant again” or “It was still very early.”

Statements such as “I know this loss was real and painful for you” are more supportive.

If sleep disturbance, panic attacks, depression, feelings of worthlessness, or thoughts of self-harm continue, urgent support from a mental health professional is necessary.

Conclusion

Pregnancy loss is both a medical and emotional experience and should not be met with blame or oversimplification.

In many cases, the cause is a random chromosomal abnormality and is not the result of the mother’s everyday behaviour.

When the experience occurs more than once or other risk factors are present, a structured evaluation of both partners can help identify treatable conditions.

Even when no specific cause is found, many couples will go on to have a healthy pregnancy in the future.

Appropriate care should consider physical health, emotional well-being, the right to make informed choices, privacy, and the person’s need for clear information.

This article is not a substitute for medical evaluation.

Heavy bleeding, one-sided pain, fainting, fever, or pain with a positive pregnancy test requires immediate medical attention.