Explore our hub on pregnancy loss here.
If you think you might be experiencing pregnancy loss, the first step is to call your doctor to set up an in-person visit. They will ask you about your symptoms, do a physical exam, and likely do an ultrasound to determine the status of your pregnancy. Below is a breakdown of what to expect from this visit and what might occur.
The waiting period for confirmation: Before you see your doctor, it’s important to know that it is common for there to be a waiting period before you can get an appointment. Once you’re seen, depending on how far along you are, you might not get a clear answer right away. This is for a few different reasons.
Commonly, among the things a doctor or midwife might look for:
- Progression of growth of the embryo
- The presence of a heartbeat within a normal range of speed
- Whether any blood is present near the embryo
The age of your embryo informs normal ranges for size and heartbeat speed, but the number of weeks gestation can be difficult to identify. While you may think you are 8 weeks out from your last period, the embryo may only appear to be 6 weeks along. Your doctor may not be able to know if the measurement is smaller because you ovulated later than you thought or because the size is lagging due to an issue with the pregnancy. In other circumstances, your doctor may note that the embryo is the correct size, but that the heartbeat is a bit slower than expected. Alternatively, they may identify that there is blood near the embryo. All of these instances may imply the possibility of a pregnancy loss, but they also may not. This period of waiting and uncertainty is an unfortunate reality that many experience. If your pregnancy loss has been confirmed, see our article on Pregnancy Loss: Treatment Options and What to Expect.
How is a miscarriage detected or diagnosed?
Pregnancy loss is typically discovered in one of two ways:
- Onset of symptoms: In some cases, early pregnancy loss can be diagnosed based on your symptoms — about 80% start with bleeding and cramping — and a physical exam. That said, bleeding in the first trimester of pregnancy is fairly common, occurring in 15 to 25% of people and is not necessarily indicative of a loss. In fact, most people with first-trimester bleeding will not experience miscarriage, so an ultrasound and/or a blood test is almost always needed. If you experience any bleeding — in particular heavy bleeding — or significant cramping, it is definitely prudent to call your doctor.
- An ultrasound: An ultrasound (usually performed transvaginally, meaning the wand is inserted in the vagina) is often necessary to establish a diagnosis and determine a pregnancy loss. But even with an ultrasound, it’s not always completely clear whether a loss has occurred. There are some ultrasound findings that are considered “non-diagnostic,” meaning they are inconclusive at that time. In some cases, your doctor will wait and repeat a sonogram in a few days to a week or alternatively, order blood work (like HCG and progesterone level tests). In either case, you may have to wait to know for sure, and your doctor will discuss next steps.
What are some symptoms of a miscarriage?
There are signs and symptoms that often accompany pregnancy loss. That said, some of the symptoms below, like bleeding and the absence of pregnancy symptoms, may also be completely normal and not indicative of an issue. Always talk to your doctor, and don’t try to self-diagnose.
- Vaginal bleeding: Heavy bleeding can be a sign of a possible pregnancy loss. Bright red bleeding or spotting that occurs immediately after intercourse, a bowel movement, or lifting something heavy is often less concerning, as it typically means the surface of your cervix was simply irritated. Similarly, if you notice brown discharge 1 to 2 days after any of these activities it implies the bright red blood did not come out and got “digested” in the vagina and then came out as brown discharge instead. That said, any bleeding warrants a call to your doctor as bleeding associated with miscarriage can range from brown discharge to heavy bleeding with or without clots (not unlike menstrual bleeding).
- Abdominal pain early in pregnancy: If you experience abdominal pain or cramping, it’s a good idea to call your doctor. This is especially important if you have not yet seen a doctor to confirm your pregnancy and are spotting, bleeding, or experiencing pain on one side of your body, a potential sign of an ectopic pregnancy, which occurs when a fertilized egg implants outside of the uterus.
- The absence of pregnancy symptoms: Some people note a reduction in pregnancy symptoms, such as decreased breast tenderness, nausea, or vomiting when experiencing pregnancy loss. It’s important to note that absence of these symptoms doesn’t always indicate miscarriage.
- A sudden migraine headache: Some people report the sudden onset of a severe migraine-type headache (like a premenstrual migraine) due to a sudden drop in pregnancy hormones (estrogen specifically) when a pregnancy loss occurs. This is especially true when this happens in someone who doesn't typically get headaches.
- No symptoms: Some people are totally asymptomatic. If you lose a pregnancy without having any symptoms, it’s often referred to as a “silent” or “missed” miscarriage. You can learn more about the types of pregnancy loss here.
What causes miscarriage?
More than half (and possibly as much as 90%) of pregnancy losses are the results of random chromosomal abnormalities that have nothing to do with your fertility status, health, habits, or anything you’ve done during your pregnancy. See our article on the Causes of Miscarriage to learn more.
What are treatment options for a miscarriage?
Depending on how far along you are, there a few different paths forward.
- Expectant Management
- Medical Management
- Dilation & Curettage
See our article on Pregnancy Loss: Treatment Options and What to Expect for more information on treatment options.
Does pregnancy loss indicate fertility issues?
Pregnancy loss is common, normal, and doesn’t necessarily say anything about your fertility. By and large, it is a one-time occurrence — about 98% of people go on to have a healthy pregnancy the next time they become pregnant. If you experience two consecutive pregnancy losses, that doesn’t mean you’ll never have a baby. In fact, the predicted risk of pregnancy loss in a future pregnancy only goes up 8% (from 20% to 28%) after two consecutive losses. After three or more consecutive losses, the risk of another pregnancy loss is about 43%. After 2 consecutive pregnancy losses (with no live birth in between), it’s appropriate to see your doctor, so they can initiate a work up or send you to a reproductive endocrinologist for an evaluation to ensure there is no need for intervention. See our article on the Causes of Miscarriage to learn more about what can increase and decrease your risk of pregnancy loss.
How long should you wait to conceive?
After losing a pregnancy, it’s normal to wonder when is safe to try to get pregnant again. If you feel ready, you don’t need to wait. Prior to 2017, doctors typically gave the non-evidence based recommendation to “wait a few cycles'' before trying again. That changed in 2017 when a prospective trial found that the optimal time to get pregnant again after early pregnancy loss was actually within 3 months. The trial concluded that conceiving again within 3 months of loss was associated with the lowest risk of subsequent miscarriage. Be your own guide on when you feel ready to try to get pregnant again.
Find more articles at our hub on pregnancy loss here.