Miscarriage is the loss of a pregnancy before 20 weeks, and it happens in about 10-20% of known pregnancies. The most common signs are vaginal bleeding and cramping, but bleeding does not always mean a miscarriage is happening. You should contact your doctor or midwife right away if you experience any vaginal bleeding during pregnancy, especially if it is heavy, or if you have severe lower abdominal or back pain.
What Are The Most Common Signs Of A Miscarriage?
Vaginal bleeding is the symptom most often linked to miscarriage. This can range from light spotting to heavy bleeding with clots. Some women pass gray or pink tissue, which can be a sign that the pregnancy tissue is being expelled.
Cramping and pain are also common. These cramps feel like strong menstrual cramps and are located in the lower abdomen or lower back. The pain can be constant or come and go in waves.
A sudden decrease in pregnancy symptoms, like breast tenderness or nausea, can also occur. However, this is less reliable on its own because these symptoms naturally fluctuate in early pregnancy.
If you notice a combination of bleeding and cramping, this is more concerning than either symptom alone. Any of these symptoms warrant a call to your healthcare provider.
How Heavy Does Bleeding Need To Be To Worry?
Light spotting that is pink or brown and does not soak a pad is common in early pregnancy. Many women spot and go on to have healthy pregnancies. Spotting alone does not mean you are having a miscarriage.
Heavier bleeding is more concerning. Bleeding that soaks through a pad in an hour or less is considered heavy. Passing large clots, larger than a golf ball, is also a reason to seek medical attention.
Bleeding that becomes heavier over time, rather than staying light, is another warning sign. If you are soaking through pads and experiencing significant cramping, this pattern is more consistent with a miscarriage.
Do not wait for bleeding to become heavy before calling your provider. Any first-trimester bleeding should be reported so they can decide if you need an evaluation.
What Does Miscarriage Cramping Feel Like?
Miscarriage cramps are caused by the uterus contracting to empty its contents. They are often described as a dull, aching pain in the lower belly or lower back that comes in rhythmic waves.
The intensity can vary. Some women feel only mild pressure, while others experience severe pain. The pain may be stronger than normal period cramps and can be accompanied by a persistent backache.
Severe pain that is sharp, one-sided, or located in the shoulder tip is different. This type of pain can be a sign of an ectopic pregnancy, which is a pregnancy implanted outside the uterus. This is a medical emergency and requires immediate care.
If your pain is severe enough to interfere with daily activities or is accompanied by dizziness or fainting, seek emergency medical care.
When Should You Go To The Emergency Room?
Most miscarriages do not require an emergency room visit. Your regular OB-GYN or midwife can usually manage the situation in their office or over the phone. However, some symptoms require immediate emergency care.
Go to the emergency room if you have bleeding so heavy that you soak through a pad every hour. Also seek emergency care if you pass tissue and have severe pain, or if you feel lightheaded, faint, or have a fever over 100.4°F.
Fever combined with bleeding can indicate an infection in the uterus, which needs prompt treatment. Shoulder pain or severe one-sided abdominal pain can indicate an ectopic pregnancy and requires immediate evaluation.
If you are Rh-negative blood type, you will need a medication called Rh immunoglobulin after any bleeding. This prevents your body from making antibodies that could harm a future pregnancy. Your provider will determine if this is needed.
Can A Miscarriage Happen Without Bleeding?
Yes. This is known as a missed miscarriage, sometimes called a silent miscarriage. In this situation, the embryo has stopped developing, but the body has not yet recognized the loss.
There may be no bleeding or cramping at all. The pregnancy may seem completely normal until an ultrasound reveals no heartbeat. Some women notice that their pregnancy symptoms fade, but others feel pregnant for weeks.
Missed miscarriages are often discovered during a routine prenatal visit. When this happens, a woman may choose to wait for natural miscarriage to begin, take medication to start the process, or have a minor surgical procedure called a D&C.
Any of these options are valid. Your healthcare provider can explain the risks and benefits of each approach so you can make an informed decision.
What Tests Confirm A Miscarriage?
Doctors use a combination of ultrasound and blood tests to diagnose a miscarriage. An ultrasound can show whether the pregnancy is growing and whether a heartbeat is present.
Blood tests measure human chorionic gonadotropin, or hCG, which is a hormone produced during pregnancy. In a healthy early pregnancy, hCG levels rise steadily. In a miscarriage, levels may fall or fail to rise appropriately.
A single hCG level is not enough to diagnose a miscarriage. Doctors usually need two blood tests taken 48 hours apart to see the trend. A single ultrasound may also be inconclusive if the pregnancy is very early.
Sometimes a diagnosis takes several days. This waiting period is difficult, but it ensures that the diagnosis is accurate before any treatment decisions are made.
What Causes A Miscarriage?
Most miscarriages in the first trimester are caused by chromosomal abnormalities in the embryo. These are random errors that occur as the cells divide and are not related to anything the mother did.
These abnormalities are typically not inherited. They happen by chance and are more common as maternal age increases. The risk of miscarriage rises with age, particularly after 35.
Other causes include hormonal problems, uterine abnormalities, and certain medical conditions like poorly controlled diabetes or thyroid disease. Infections and immune system disorders can also play a role in some cases.
Importantly, common activities do not cause miscarriage. Exercise, sex, lifting, stress, and falls are not proven causes of pregnancy loss. Most miscarriages cannot be prevented because the cause is genetic.
What Happens After A Miscarriage?
Physical recovery usually takes a few weeks. Bleeding typically lasts 1-2 weeks after a miscarriage, though it can be longer. Your period usually returns within 4-6 weeks.
You can ovulate before your first period returns, which means you can get pregnant again quickly if you choose. Many doctors recommend waiting until you have one normal period before trying again, but the evidence supporting this is limited.
Emotional recovery is different for everyone. Grief after a miscarriage is real and valid, regardless of how early the loss occurred. Some women find support groups or counseling helpful.
If you have had two or more consecutive miscarriages, your doctor may recommend testing to look for underlying causes. After one miscarriage, most women go on to have a healthy pregnancy.
Frequently Asked Questions
Can stress cause a miscarriage?
No, everyday stress has not been proven to cause miscarriage. Severe, prolonged stress may have health effects, but it is not an established cause of pregnancy loss.
How long does miscarriage bleeding last?
Bleeding typically lasts 1-2 weeks after a miscarriage. Contact your doctor if bleeding becomes heavy again after slowing down or if it lasts longer than two weeks.
Can you have a miscarriage without knowing you are pregnant?
Yes, this can happen when a very early miscarriage occurs around the time of an expected period. The bleeding may be mistaken for a slightly late or heavier period.
Is brown discharge a sign of miscarriage?
Brown discharge is old blood and is often harmless in early pregnancy. It can also be an early sign of miscarriage, so report it to your provider for guidance.
