It’s probably the biggest pregnancy anxiety but sometimes miscarriage is shrouded in myth and secrecy. Here are the facts you need to know.
Some women have no obvious signs of a miscarriage and only have it diagnosed during a scan. Other women have symptoms that can be intense, including bleeding or spotting, with or without stomach pain or cramps (NHS Choices, 2018a; Miscarriage Association, 2018a). Some pass clots or ‘stringy bits’.
When symptoms do occur, they don’t always result in a miscarriage and may be part of a normal pregnancy. So if you get them, try not to panic.
Miscarriage symptoms and signs: Bleeding
Bleeding can vary from light spotting or brownish discharge to heavy bleeding and bright red blood (Miscarriage Association, 2018a). It might come and go over several days.
Try to remember that light vaginal bleeding is relatively common during the first trimester (the first 12 weeks) and definitely isn’t a sure sign that you're having a miscarriage. One study found that in the first 20 weeks of pregnancy, 21% of the women experienced vaginal bleeding and 12% had a miscarriage after that (Everett, 1997). This means about half of the women who had vaginal bleeding continued having a healthy pregnancy.
Bleeding could be caused by any of the following:
Implantation: In early pregnancy, you might get some harmless light bleeding (spotting), when the developing embryo plants itself in the wall of your womb. This often happens when your period would have been due.
Cervical changes: Pregnancy can cause changes to the cervix, and this may cause bleeding, for example after sex.
Ectopic pregnancy: When a fertilised egg implants outside the womb, such as in the fallopian tube, it can't develop properly. Symptoms are: a sharp, sudden and intense pain in your tummy, feeling very dizzy or fainting, and feeling sick or looking very pale. Call 999 or go to your nearest accident and emergency (A&E) department if you get a combination of those symptoms.
(NHS Choices, 2016; NHS Choices, 2018b)
If you start bleeding during pregnancy, contact your GP, midwife or the early pregnancy unit at your local hospital as soon as possible. If your symptoms are not severe and your baby is not due for a while, you'll be monitored. Some women may have to stay in hospital for observation (NHS Choices, 2018b).
How will I know what’s causing my bleeding?
You may need to have a vaginal or pelvic examination, an ultrasound scan or blood tests to check your hormone levels. Your doctor will also ask you about other symptoms but sometimes it might not be possible to find out what’s caused the bleeding.
Miscarriage symptoms and signs: Stomach pain
Stomach pain might be due to an upset tummy or constipation. Some women experience lower stomach cramps because of the recent implantation of the fertilised egg in the wall of the uterus. You can also get cramps in the early weeks because your womb is stretching and growing (Marcin, 2017).
If you have bleeding or spotting as well as pain, that may be a sign of miscarriage (Miscarriage Association, 2018a). Contact your GP or early pregnancy unit.
If you have sharp abdominal or one-sided pain or pain in your shoulders, and/or pain when you poo, go to A&E. They’ll give you an emergency scan. It’s especially important to get help if you have had an ectopic pregnancy before (NHS Choices, 2018a; Miscarriage Association, 2018a).
If pregnancy symptoms go away, is that a sign of miscarriage?
The sudden disappearance of pregnancy symptoms like nausea or cravings can also sometimes be a sign of miscarriage. But this doesn’t necessarily mean there is a problem. Some women don’t get many pregnancy symptoms anyway.
If you’ve been having strong pregnancy symptoms that suddenly reduce or stop well before you’re 12 weeks pregnant, your hormone levels might be dropping. You may want to do another pregnancy test and/or talk to your GP about a scan (Miscarriage Association, 2018a).
Miscarriage: How do you know for certain?
Miscarriage is usually diagnosed or confirmed with an ultrasound scan. It may take more than one scan to confirm it for definite.
In later (second trimester) pregnancy, bleeding, pain and passing a recognisable pregnancy sac or delivering a baby often confirms what has happened without a scan.
Miscarriage: What happens afterwards?
If there's no pregnancy tissue left in the womb, no treatment is required. If there is, your options to remove the tissue are as follows:
Wait 7 to 14 days after a miscarriage for the tissue to pass naturally. If the pain and bleeding don’t start within that time or are getting worse, you should get another scan and discuss your options.
Take medication if you don’t want to wait or if waiting hasn’t worked. This might involve using mifepristone first, followed 48 hours later by misoprostol.
Have tissue surgically removed. This may be advised if you have continuous heavy bleeding, infected pregnancy tissue, or if waiting and medication hasn’t enabled the tissue to pass.
(NHS Choices, 2018c)
Discuss your options with the doctor in charge of your care and read more about available treatments on the NHS Choices website
If your blood group is rhesus negative (RhD negative), you should be offered injections of a medication called anti-D immunoglobin afterwards. This prevents rhesus disease, which is a condition where antibodies in a pregnant woman's blood destroy her baby's blood cells (NHS Choices, 2018d).
Contact your hospital immediately if your bleeding becomes particularly heavy, you develop a high temperature, or you experience severe pain.
You should be advised to take a home pregnancy test after three weeks. If you're still pregnant, you may need further tests to make sure you don't have a molar pregnancy (an abnormal fertilised egg implanted) or an ectopic pregnancy (NHS Choices, 2016; Miscarriage Association, 2018b).
For more help and advice on all pregnancy loss, contact The Miscarriage Association