What is a Missed Miscarriage?
When you first find out you are pregnant it is a time of excitement and hope. For those who have had a difficult time conceiving or have suffered previous pregnancy losses it can be a stressful time as well.
Miscarriage occurs in anywhere between 10-25% of pregnancies and usually occurs prior to 20 weeks gestation. A pregnancy loss can be caused by a number of factors including physical trauma, chromosomal abnormalities, or disease. Or you may experience a blighted ovum which is when an embryo implants in the uterus but doesn’t develop into a baby.
Close to 50-75% of pregnancy losses are what is called chemical pregnancies. This type of loss occurs when a pregnancy ends shortly after implantation. The woman may not even know she was pregnant and the minimum bleeding might be mistaken as an expected period.
Sometimes the reason for a miscarriage is not known. If you experience symptoms of a miscarriage it is important to contact your doctor right away.
The most common miscarriage symptoms include:
- Heavy Bleeding
- Severe cramping
- Severe abdominal/belly pain
- Dull pain in your lower back, this can feel like pressure as well.
- Changes in vaginal discharge
- True contractions happening every 5-20 minutes
These symptoms are more common in loss later in pregnancy, but some women may experience a miscarriage early in pregnancy and not realize it. It is possible for the embryo to stop developing and remain in the uterus with the body continuing to produce hormones and symptoms of pregnancy. This is known as a missed miscarriage.
What is a missed miscarriage?
Also known as a silent miscarriage, a missed miscarriage is when the baby has died or not developed, but there have been no physical signs that something is wrong. This may occur before a woman even realizes she is pregnant or in the very early stages of pregnancy.
In a missed miscarriage false positive pregnancy tests can occur as a result of pregnancy hormones remaining high. And if you are early in your pregnancy you may not be able to feel the baby move or kick and therefore don’t notice any changes.
While it is common to not have the more well-known symptoms of a miscarriage, you may notice subtle signs of a miscarriage including:
- Decreased breast tenderness
- Improved nausea symptoms
- Decreased fatigue
- Small amount of brownish or red vaginal discharge
- Overall improvement in pregnancy symptoms
However, as the name implies this type of miscarriage is often not noticed until you go to a doctor’s appointment.
Diagnosing a missed miscarriage
For most women who suffer a silent miscarriage they head into their early pregnancy scan with no idea that anything is wrong. A missed miscarriage is typically diagnosed when an ultrasound is done prior to 20 weeks of pregnancy and no fetal heartbeat is found or the embroy appears too small for the progression of the pregnancy.
Given that it can sometimes be difficult to find a heartbeat in early ultrasounds and the date of conception could have been miscalculated, your doctor will most likely ask you to come back in one to two weeks for a follow-up scan to verify a miscarriage.
Once a miscarriage has been confirmed your health care provider will discuss your best options for treatment. There are several treatments for removing the embryo from the body and ensuring you don’t experience other complications such as infection.
Treatment options might include:
- Expectant management – wait for the body to pass the embryonic tissue on its own
- Medical management – take a medication that will trigger your body to pass the tissue
- Surgical management – Dilation and curettage (D&C) surgery may be required if your body doesn’t pass the tissue on its own or medication doesn’t work
Your health care provider will be able to work with you on the best treatment option and managing your recovery. Physically it can take weeks or months to recover and return to normal periods. Emotional recovery can take longer and allowing yourself the time to work through your loss is important. Finding the right emotional support is a key part of your recovery.
If you experience a loss of a pregnancy know that you aren’t alone and there are resources for support in this difficult time. Your doctor should be able to provide information on support and resources or here are a few to assist during your time of loss:
Pregnancy loss is a unique experience for every person and allowing yourself to recover is part of your physical and emotional journey. When you feel you are ready to continue trying to conceive, discuss your health with your doctor and see if they have any tests or recommendations for your next pregnancy.
✔️ Medically Reviewed by Banafsheh Kashani, MD, FACOG
Banafsheh Kashani, M.D., FACOG is a board-certified OB/GYN and specialist in reproductive endocrinology and infertility at Eden Fertility Centers, and has been treating couples and individuals with infertility since 2014. Prior to joining Eden Centers for Advanced Fertility, she was practicing as a top fertility specialist at Kaiser Permanente in Orange County and Reproductive Fertility Center. Dr. Kashani has received numerous awards throughout her years of study and medical training.
Dr. Kashani has conducted extensive research in female reproduction, with a specific focus on the endometrium and implantation. Additionally, Dr. Kashani has authored papers in the areas of fertility preservation, and fertility in women with PCOS and Turners syndrome. She also was part of a large SART-CORS study evaluating the trend in frozen embryo transfers and success rates.
Dr. Kashani is a fellow of the American Congress of Obstetricians and Gynecologists. In addition, she is a diplomat of the American Board of Obstetrics and Gynecology and an active member of the American Society of Reproductive Medicine (ASRM) and Pacific Coast Reproductive Society (PCRS). She is also a member of the Society of Reproductive Endocrinology and Infertility (SREI).