Signs of a miscarriage and next steps

What is a miscarriage?

The loss of a pregnancy before 24 weeks is called a miscarriage (NHS, 2026). Miscarriage in the first three months is experienced by 1 in 5 women and birthing people and may happen before a pregnancy has been confirmed (RCOG, 2016).

What are the signs?

Some women or birthing people have no obvious signs of a miscarriage. It may only be found during a routine antenatal scan (NHS, 2026).

The most common sign is vaginal bleeding or discharge. Bleeding can be light or dark in colour and range from spotting to heavy bleeding that includes clots (NHS, 2026).

Other possible symptoms that should be mentioned to the midwife as soon as possible include (NHS, 2026; Miscarriage UK, no date):

Cramping or pain
No longer being aware of previously strong pregnancy symptoms
A sudden gush of fluid from the vagina
Diarrhoea
Just not feeling right

Experiencing these symptoms does not necessarily mean that the woman or birthing person is having a miscarriage, but the maternity unit or early pregnancy unit should be made aware. Contact details may be in the maternity notes, or call NHS 111 (NHS, 2026).

Symptoms that need urgent treatment in an emergency department are (NHS, 2026):

A sudden, sharp and intense pain where it is difficult to do anything else
Pain in the shoulder
Feeling dizzy, lightheaded or fainting
Bleeding that quickly soaks through a pad (do not put anything into the vagina, as it may increase the chance of infection)

These may be signs of an ectopic [Ek-top-ik] pregnancy. This is when a fertilised egg implants outside the womb, such as in the fallopian tube (Miscarriage UK, no date). On arrival at A&E say that you are anxious about an ectopic pregnancy.

How will I know for certain?

The midwife or doctor will ask questions about the pregnancy and general health. The mother or birthing person may be offered a urine test, blood test, and internal ultrasound. This is a scan done via the vagina to look for a heartbeat and check development (NHS, 2026).

However, if it’s less than six weeks of pregnancy it can be too early to see a heartbeat on a scan. The woman or birthing person may have to return for another scan a week or two later (Miscarriage UK, no date).

What happens next?

It is not possible to stop a miscarriage that has started. The next steps will depend on the stage of pregnancy (NHS, 2026).

Before 14 weeks of pregnancy the options are (NHS, 2026; RCOG, 2016):

Waiting for symptoms to pass naturally while at home. This is usually within two weeks, and for 50 in 100 this option needs no further treatment. A follow up appointment will confirm if any further action is needed.
Medication to cause the remains to pass out of the womb. It may be possible to go home after taking medication, or it may be recommended to stay in hospital for monitoring. This is effective for 85 in 100 women and birthing people.
An appointment for gentle suction via the vagina under general or local anaesthetic. It may be possible to go home the same day. This treatment is successful for 95 in 100 women and birthing people.

Between 14 and 23 weeks a care team will discuss the options and support you. These options will be (NHS, 2026):

Spontaneous labour
Medication to start labour

Caesarean birth is not usually offered for miscarriage.

Physical recovery

Physical symptoms will include cramping pain for a couple of days, and vaginal bleeding for up to two weeks. To support recovery, it is recommended to rest and use over the counter pain relief (NHS, 2026).

It’s advised to avoid penetrative sex until all physical symptoms have gone, as this could risk an infection (NHS, 2026).

If pain or bleeding are not getting better after a few days, seek medical advice from the GP or pregnancy unit (RCOG, 2016).

If experiencing increasing pain, smelly vaginal discharge, fever or vomiting seek urgent medical help. This may require antibiotics or admission to hospital (RCOG, 2016).

Emotional recovery

Miscarriage is an emotionally difficult event for the whole family. It may be helpful for the mother or birthing person to talk to family and friends about how they feel. Counselling may be available from the GP or pregnancy unit for both them and the partner (NHS, 2026).

Information and support are available from a range of organisations, who can help with remembrance and dealing with grief. These include Miscarriage UK and The Ectopic Pregnancy Trust, which offers specialist support after an ectopic pregnancy.

An optional Baby Loss Certificate is available in England for babies lost before 24 completed weeks of pregnancy.

Finding the cause

There is normally no investigation of a single miscarriage, as they are common. They are thought to be mostly due to a problem with the baby’s genes (RCGO, 2016).

Some women or birthing people experience three or more miscarriages, sometimes with healthy pregnancies in between. This is called recurrent miscarriage, and it affects 1 in 100 women and birthing people (RCOG, 2023).

In this situation they will be referred to a Recurrent Miscarriage Clinic. Tests will be offered to look for a possible cause. This can include blood tests, genetic tests, and a scan of the uterus. It may also include testing of sperm (RCOG, 2023).

Depending on the results of the tests some treatment may be offered. However, it is common for miscarriage to remain unexplained (RCOG, 2023).

Some things that may increase the chance of miscarriage are outside the woman or birthing person’s control. For example, age, ethnicity, or chronic disease (NHS, 2026).

There are some factors linked to a risk of miscarriage that may be under their control. However, it is important to note that this does not mean they caused the miscarriage. These include (NHS, 2026; Miscarriage UK, no date b):

Vitamin D deficiency
Smoking
High levels of caffeine
Alcohol
Being under or overweight
Exposure to harmful chemicals or air pollution
Stress and having sex are not associated with miscarriage (RCOG, 2016).

Having sex

Once the physical symptoms have gone and there is no risk of infection, it is fine to have penetrative sex again (NHS, 2026).

It can take up to 8 weeks for periods to start, and longer for them to return to their normal pattern (NHS, 2026). However, contraception should be used straight away if another pregnancy is not desirable at this time.