Signs of Miscarriage
What is a miscarriage?
A miscarriage is a fairly common complication of early pregnancy, in which the developing embryo or fetus dies in the womb. The term miscarriage is used to describe this process when it happens during the first 20 weeks of pregnancy.
A miscarriage which occurs in the first trimester (weeks 1-12 of pregnancy) is known as an early miscarriage. A miscarriage which occurs in the second trimester weeks 13-20 of the pregnancy) is known as a late miscarriage. (Loss of the fetus which occurs after week 20 of pregnancy is known as a stillbirth.
Immediate medical attention should be sought if signs of miscarriage are present, so that doctors can find out if a miscarriage is taking place and provide any treatment needed. They may need to run diagnostic tests to see if a miscarriage is occurring, such as checking for levels of the pregnancy hormone human chorionic gonadotropin (hCG) in the blood and/or urine, and an ultrasound scan to detect the fetal heartbeat.
Some of the possible signs of miscarriage, such as bleeding and cramping, are not always a cause for concern, as they can also be present as symptoms of other processes that the body goes through during a healthy pregnancy. If a pregnant person’s symptoms do not indicate a miscarriage, the check-up will be an opportunity to identify any other possible complications with the pregnancy and/or to offer them reassurance that the fetus is developing normally.
Symptoms of miscarriage
The main signs of miscarriage are pain, cramping and vaginal bleeding, which intensify as the miscarriage progresses. It is also possible to experience a miscarriage without perceiving any signs that it is taking place: many miscarriages are diagnosed during a routine ultrasound scan.
When present, common signs of a miscarriage are:
- Abdominal pain
- Vaginal bleeding
- Discharge of fluid or tissue from the vagina
- Loss of pregnancy symptoms, such as nausea and breast tenderness
It is normal for the symptoms of early pregnancy, such as nausea, vomiting and implantation bleeding, to ease off towards the end of the first trimester, as the body adjusts to the pregnancy. However, a sudden loss of pregnancy symptoms, which had previously been pronounced, may indicate a miscarriage.
Differences between first- and second-trimester miscarriage symptoms
Although the signs of a miscarriage ‒ including vaginal bleeding and discharge and abdominal pain ‒ are broadly the same whether the miscarriage occurs in the first or second trimester, there are some differences in their specific characteristics.
- A greater volume of discharge and vaginal bleeding: A person is more likely to see blood clots in their vaginal discharge in the second trimester. These are likely to be larger and thicker than those passed in the first trimester. Vaginal bleeding during the second trimester is more likely to be related to a miscarriage than bleeding during the first trimester; light vaginal bleeding is common in the first trimester and can be unrelated to miscarriage.
- More severe abdominal pain: Cramping and abdominal pain are common symptoms of miscarriage in both the first and second trimesters. However, the severity of this symptom is greater in a second-trimester miscarriage and is unlikely to respond to traditional pain-relieving techniques such as taking a hot bath, lying in certain positions or taking over-the-counter pain-relief medications suitable for pregnant women.
- More severe back pain: Back pain can occur in both early and late miscarriage. It is possible to experience back pain in both trimesters without it relating to a miscarriage, as it is a normal side-effect of carrying a growing fetus in the womb. However, intense pain in the lower back is commonly a feature of late miscarriage. It results from the muscles in the lower back working to expel the fetus.
- Loss of fetal movement: In many pregnancies, the movements of the developing fetus can be felt from around week 20 of pregnancy. Decreased or absent fetal movement may indicate miscarriage. However, it can also indicate other possible problems with the pregnancy and does not necessarily mean that the fetus has died. If the fetus is moving less than normal, or appears to have stopped moving altogether, prompt medical investigation will be necessary to diagnose miscarriage or other possible problems.
During the second trimester, the presence of symptoms like vaginal bleeding, abdominal pain or back pain is more likely to indicate a miscarriage than to relate to benign factors associated with a healthy pregnancy, such as implantation bleeding. Medical attention should be sought promptly, especially if a pregnant person experiences these symptoms in the second trimester.
Other possible explanations for the symptoms of miscarriage
A person who is miscarrying may experience some, all, or none of the symptoms of miscarriage. However, the presence of symptoms is not always a sign that a miscarriage is taking place: it is possible to experience bleeding, cramping, discharge and pain in the course of a healthy pregnancy.
Other causes for the symptoms of miscarriage include:
- Implantation bleeding: Light vaginal bleeding or spotting is commonly experienced by pregnant people around the time the fertilized egg implants in the uterus.
- Light vaginal bleeding as a symptom of early pregnancy: Aside from implantation bleeding, light vaginal bleeding and spotting are also commonly present at intervals during the first trimester (the first 12 weeks of pregnancy). Their presence does not always mean that one is having an early miscarriage. Bleeding which occurs after the first trimester is more likely to be related to a pregnancy complication such as miscarriage.
- Blood flow to the vaginal area in pregnancy: Many women produce a greater quantity of vaginal discharge than usual during pregnancy as more blood flows to the vaginal area.
- Normal pain and cramping associated with pregnancy: Some pain and cramping are features expected of a healthy pregnancy. It is common to experience stomach aches and constipation, which may cause pain, especially back pain, and cramping. These symptoms of pregnancy will often worsen as the fetus develops.
- The body adapting to pregnancy: Many women experience symptoms of pregnancy such as nausea, vomiting and breast tenderness. These symptoms generally lessen or become absent as the pregnancy progresses ‒ particularly after the first 12 weeks ‒ and so experiencing a loss of pregnancy symptoms is not always a sign of miscarriage or a cause for concern.
Vaginal bleeding in combination with abdominal pain and/or cramping is more likely to be indicative of a miscarriage than the presence of any of these symptoms on their own. Many people become concerned that they are having a miscarriage, if any of its possible symptoms occur ‒ particularly vaginal bleeding ‒ and it is advisable to seek medical attention to check if there is a problem.
Other complications of pregnancy, which may also produce some of the symptoms associated with miscarriage, include:
- Ectopic pregnancy: Also known as a tube pregnancy, this occurs when the embryo attaches outside the uterus (womb). As with a miscarriage, abdominal pain and vaginal bleeding are two principal signs of ectopic pregnancy.
- Molar pregnancy: This occurs when a lump of abnormal cells grows in the womb, instead of a healthy embryo. As with a miscarriage, vaginal bleeding is a principal sign of molar pregnancy.
Good to know: A person can undergo an early pregnancy ultrasound scan if they suspect a miscarriage. This can put their mind at ease and/or detect any complications with the pregnancy. It is always worth consulting a medical professional if a person is worried about any potential problems with their pregnancy; a medical professional is unlikely to turn a person away if they perceive any cause for concern.
Types of miscarriage and their symptoms
It is possible to have a miscarriage without being aware of or experiencing any related symptoms such as bleeding, cramping or pain. Types of miscarriage in which symptoms may not be discernible by the pregnant person include:
- Missed miscarriage: Many miscarriages are diagnosed during a routine ultrasound scan in the course of a pregnancy apparently progressing normally, due to detecting the absence of a fetal heartbeat. Before the scan, one possible warning sign of a missed miscarriage may be that the baby or bump is smaller than it should be at this stage. No pregnancy tissue or fetal matter will pass out of the womb in a case of missed miscarriage, and the physical miscarriage may have to be medically induced.
- Chemical pregnancy: Many miscarriages take place because the fertilized egg fails to fully and properly implant in the uterine lining. This kind of miscarriage often occurs before a person is necessarily aware that they had become pregnant. In a miscarriage related to chemical pregnancy, the lost fertilized egg and pregnancy tissue may be mistaken for a person’s next menstrual period, and they may therefore be unaware of miscarrying.
A miscarriage can be complete or incomplete, depending on whether all or part of the fetal matter and pregnancy tissue passes out of the body after the miscarriage begins:
- Complete miscarriage: The entirety of the fetal matter and pregnancy tissue pass out of the uterus naturally and rapidly through the cervix, the lowest part of the womb, connecting it to the vagina, after the miscarriage begins. Pain, bleeding and cramping will typically be experienced as the fetal matter and pregnancy tissue are passed. There is usually no need for further medical treatment, and doctors will advise on appropriate aftercare and possible psychological interventions to help a person process the experience of miscarrying.
- Incomplete miscarriage: Only part of the fetal matter and pregnancy tissue exit the womb. Pain, bleeding and cramping will typically be experienced as this is passed. Further medical treatment will be needed to identify the extent of the remaining fetal matter and pregnancy tissue and to remove it.
Signs of miscarriage in diagnostic tests
A pregnant person should seek medical attention at the first sign(s) of a suspected miscarriage. The diagnostic tests to confirm a miscarriage and possible treatment options will depend on the type of miscarriage a person is having.
- Human chorionic gonadotropin (hCG) test: To test for the presence of the pregnancy hormone in the blood and/or urine. Doctors will look out for low or diminishing levels of hCG compared to the levels of hCG expected for the person’s stage in pregnancy.
- Pelvic exam: Doctors will examine whether the cervix is dilated and check for the presence of blood and/or pregnancy tissue in the cervical opening, both signs that can indicate miscarriage.
- Ultrasound scan: This is a non-invasive, safe imaging technique which uses soundwaves to create images of the developing fetus and pregnancy sac. During a scan, doctors will look out for signs of miscarriage including an empty pregnancy sac in the uterus, pregnancy tissue but no fetus in the uterus, and/or a fetus or embryo which is smaller than it should be by this stage of pregnancy. If the pregnancy is far enough advanced for the scan to detect a fetal heartbeat - after week seven of pregnancy - then doctors will also look out for the lack of a fetal heartbeat.
- Fetal heart scanning: Fetal heart scanning is a special type of ultrasound scan which produces detailed images of the baby’s heart. The absence of a fetal heartbeat is a conclusive sign of miscarriage.
See this resource on miscarriage for further information about undergoing the procedures for diagnosing miscarriage.
In the second trimester (in a late miscarriage), there may be no need for these tests to confirm the diagnosis, but any or all of them will be performed if necessary. However, the miscarriage may be conclusively evidenced by symptoms including:
- Abdominal pain
- Passing a recognisable pregnancy sac or tissue
- Delivering the fetus
In this instance, tests such as an autopsy on the pregnancy tissue or a placental exam may be performed to help determine the possible causes of the miscarriage.
There are a variety of treatment options available for miscarriage, depending on the type of miscarriage that a person is undergoing. Doctors will usually recommend or prescribe appropriate over-the-counter or prescription painkillers to help manage the pain and cramping. For people who have a complete miscarriage, where all pregnancy tissue and fetal matter pass out of the uterus naturally, no further medical treatment is typically needed, but psychological treatments such as counselling may be necessary to help a person process the experience.
- Medically-induced miscarriage: This is a non-surgical treatment which involves taking a medication called misoprostol(Cytotec) in order to induce cramping in the uterus, which pushes out the remaining fetal matter and pregnancy tissue over the course of approximately 4-5 hours. One advantage of a medically-induced miscarriage is that the medication can be taken at home.
- Manual vacuum aspiration: This procedure is usually recommended for first-trimester miscarriages or as a means of removing any remaining pregnancy tissue when the fetus has already passed out of the womb. A device is inserted into the cervix to empty the womb of all pregnancy tissue and fetal matter using gentle suction. This procedure can be carried out under local anesthetic and takes around 10-15 minutes.
- Surgery: There are two possible operations for surgically inducing miscarriage, both of which are usually performed under general anaesthetic as outpatient procedures.
- Dilation and curettage (D&C) is usually performed in first-trimester miscarriages and involves using an instrument called a curette to scrape the pregnancy tissue and fetal matter out of the dilated uterus.
- Dilation and extraction (D&E) is usually performed in second-trimester miscarriages and involves using a grasping instrument called forceps to take the fetus out of the dilated uterus.
After a medically- or surgically-induced miscarriage, cramping and bleeding may continue for up to two weeks, and a person should avoid sexual activity until their next menstrual period at around 4-6 weeks after the miscarriage completes, in order to reduce the risk of infection. For more information about preparation and recovery relating to these procedures, see this resource on miscarriage.
Post-miscarriage psychological intervention such as one-on-one or group counseling may be recommended to help a person process the experience of miscarrying, and to avoid developing anxiety and depression in the aftermath of miscarriage. Doctors will be able to recommend a range of available support options.
Q: What are the signs that an infection is causing a miscarriage? A: Most miscarriages occur in the first trimester and are the result of problems with the fetus rather than infections affecting the pregnant person. In the second trimester, miscarriages are most likely to be caused by an underlying health condition, including an infection caused by bacteria such as Chlamydia or Salmonella. If a pregnant person is affected by an infection, this can spread to the site around the baby and cause the neck of the womb (cervix) to open too soon, resulting in miscarriage. There is usually no pain or bleeding when an infection causes miscarriage. The waters breaking will be the first sign of miscarriage caused by infection.
Q: Is diarrhea a sign of miscarriage? A: Diarrhea is not necessarily a sign that something is wrong with a pregnancy, and pregnant people may experience it over the course of a normal pregnancy for a variety of reasons, including adapting to a healthy pregnancy diet. However, diarrhea is sometimes indicative of food poisoning like Salmonella, Toxoplasmosis or Listeriosis, all of which are associated with an increased risk of miscarriage. If diarrhea is suspected to relate to food poisoning or an infection, seek medical attention promptly to reduce the risk of miscarriage. For more information about food poisoning as a possible cause of miscarriage, see this resource.
Q: What are the signs of miscarriage without bleeding? A: It is possible to experience a miscarriage without bleeding. Other signs that a person may be experiencing a miscarriage include cramping, pain, loss of pregnancy symptoms and passing vaginal discharge, which may be stringy and/or whitish-pink in colour. Any, all or none of these symptoms may be present. A miscarriage which is symptomless and is only detected by hospital staff during a routine ultrasound scan is called a missed miscarriage.
“Surgical care of miscarriage under local anaesthetic using manual vacuum aspiration (MVA).” Guy’s and St. Thomas’s, NHS Trust. March 2016. Accessed: 24 January 2018. ↩