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What Are Miscarriage & Stillbirth?

FACTS TO KNOW
  • It's important to know there are multiple types of pregnancy loss, and the terms used to describe them may be overwhelming or triggering.

  • Loss in First Trimester

    Approximately 80% of losses occur during the first trimester.
    In the second and third trimesters, the risk of experiencing loss is less than 1%.

  • What is the difference between miscarriage & stillbirth?

    • A miscarriage, also called early pregnancy loss, is the term used to describe a pregnancy that ends before 20 weeks.
    • Stillbirth generally refers to a pregnancy loss at 20 weeks of gestation or later. It occurs in 1 in 160 births.
  • If you think you may be experiencing pregnancy loss, contact your doctor to set up an appointment. This article provides information to help understand technical terms you may encounter.

If you’re facing a pregnancy loss or suspect you’re experiencing one, you might feel overwhelmed by the amount of information online or confused by the terms you hear from your doctor. It’s important to know that there are several types of pregnancy loss, which we’ll cover here.

Keep in mind that the terms you’ll see below are the medical terms used to describe different types of pregnancy loss; they are not always sensitive to the person experiencing the loss, and we want to recognize that they can be upsetting. We’ll define and use the terms here so that you feel more prepared if you hear them from your doctor or insurance company.

Miscarriage (Before 20 weeks)

What is a miscarriage?

A miscarriage, also called early pregnancy loss, is the term used to describe a pregnancy that ends before 20 weeks.

How common is miscarriage?

Way more common than you might think. Studies show that approximately 8 to 20% of people who know they are pregnant have a loss in the first trimester. But the actual rate of early pregnancy loss may be as high as 50% since many people have very early pregnancy loss without ever missing a period or realizing that they are pregnant. One study that followed hormone levels every day to detect very early pregnancy found a total pregnancy loss rate of 31%.

  • First trimester: Approximately 80% of pregnancy losses occur in the first trimester.
    • Before 4 or 5 weeks: Week 4 is typically when a pregnancy can be detected by a pregnancy test. Recent research suggests that as many as 50 to 75% of pregnancies end before getting a positive result on a pregnancy test.
    • Between 6 and 8 weeks: Once a pregnancy reaches 6 weeks and has been confirmed by a doctor, the risk of loss drops to 10%. Once you see the fetal heartbeat with an ultrasound, the chance of a loss drops to 5% (A fetal heartbeat is typically detectable by 6 weeks on a standard ultrasound machine).
    • Weeks 8 through 13: In the second half of the first trimester, the rate of pregnancy loss drops to between 2 and 4%.
  • Second trimester: The risk of experiencing a pregnancy loss between weeks 13 and 26 is less than 1%.
  • Third trimester: The risk of experiencing a pregnancy loss between weeks 26 and 37 remains less than 1%.

What are the different types of miscarriage?

The terms below are commonly used to describe pregnancy loss. It’s important to know that terms like "miscarriage," "blighted ovum," "spontaneous abortion," and "missed abortion" are not clearly standardized and can be used interchangeably, which may cause confusion or make you feel overwhelmed during a pregnancy loss. It should also be noted that in medical terminology, especially for billing and coding purposes and in hospitals, “abortion” is the clinical term for pregnancy loss. Seeing this can be upsetting for some.

Chemical pregnancy

According to the American College of Obstetricians and Gynecologists (ACOG), chemical pregnancies may account for 50 to 75% of all early pregnancy losses. This occurs when a pregnancy is lost shortly after implantation, resulting in bleeding that occurs around the time of your expected period. You may not realize that you ever conceived when you experience a chemical pregnancy.

Blighted ovum

A blighted ovum occurs when a fertilized egg implants in the uterus but doesn't develop into an embryo. It is also referred to as an embryonic (no embryo) pregnancy and is a leading cause of early pregnancy loss. This often occurs before pregnancy is detected, but it’s also not uncommon to see your doctor after a positive pregnancy test only to find an empty gestational sac, often labeled a blighted ovum.

Missed or silent miscarriage

A missed miscarriage is when a pregnancy loss is detected during a routine ultrasound. This can be particularly upsetting since it does not accompany any symptoms that indicate a pregnancy loss. At a routine check up, a doctor may say you’ve had a missed miscarriage if they see the sac with the embryo (called the “fetal pole”) but hear no heartbeat. You may not have symptoms of miscarriage because your body simply hasn’t started the process of cramping and bleeding, which happens when it recognizes that the pregnancy is no longer active. Know that if this happens, your doctor will discuss your options with you, and together you can decide how to proceed. Learn more about pregnancy loss treatment options and what to expect here.

Ectopic pregnancy

Ectopic pregnancy, also called extrauterine pregnancy, is when a fertilized egg grows outside your uterus, most often in the fallopian tube. An ectopic pregnancy can cause life-threatening bleeding and needs medical care right away. If you have any spotting, bleeding, or pain on either side (aside from mild, period-like cramps), you should call your doctor and be evaluated — even if you notice these symptoms as early as the first day you’ve missed your period.

Molar pregnancy

A molar pregnancy is a non-cancerous tumor that develops in the uterus as a result of a nonviable pregnancy. It’s very rare, occurring in just 1 out of 1,000 pregnancies. The pregnancy may seem normal at first, but when symptoms develop, they include dark brown to bright red vaginal bleeding during the first trimester along with severe nausea and vomiting. The tumor must be removed to avoid complications and requires close consultation with your doctor as each case can be different.

Threatened miscarriage

This term is typically used when you have vaginal bleeding early in pregnancy but no other signs of a problem (for example, a heartbeat is detected). In many people with a “threatened miscarriage,” the bleeding subsides and the pregnancy continues to term. In others, the bleeding becomes heavier and pregnancy loss occurs. If you experience this, your doctor will discuss options for monitoring your pregnancy closely moving forward. While there is no evidence to support this, some doctors may consider progesterone supplementation in this case. It’s important to be aware that the term “threatened miscarriage” may appear on billing statements from your insurance company when your doctor sees you for an episode of bleeding; this can be triggering for many people.

Inevitable miscarriage

An inevitable miscarriage means a pregnancy loss cannot be avoided. Your doctor will use this term if your cervix is open, bleeding is heavy or increasing, and abdominal cramping is present. Know that if this happens to you, you will likely have a choice to either allow the loss to occur on its own or opt to take medication or undergo a procedure that will move the process along. See our article on Pregnancy Loss: Treatment Options and What to Expect.

Incomplete miscarriage

An incomplete miscarriage means that only part of the pregnancy tissue has passed and some remains in the uterus. Typically, the fetus has been passed, but bits of the placenta remain. The cervix remains open, and bleeding may be heavy. Options are to either have a D&C (dilation and curettage), where the cervix is dilated and uterine lining is scraped, or try medical management (i.e. misoprostol) to help the uterus contract and expel what remains inside.

Complete miscarriage

This term is used when a person passes all of the pregnancy tissue. This is common in miscarriages that occur before 12 weeks of pregnancy. After the pregnancy loss, there is a period of bleeding and cramping which resolves without treatment. On examination, the clinician typically finds that the cervix is closed, and there is no sign of a pregnancy sac in the uterus. An ultrasound examination may need to be performed to confirm the diagnosis.

Septic miscarriage

It’s rare, but sometimes a pregnancy loss can also be accompanied by an infection in the uterus. This is known as a septic miscarriage and is the leading cause of death related to pregnancy loss. Symptoms include fever, chills, flu-like aches, abdominal pain, vaginal bleeding, and vaginal discharge which may be thick and may have an odor. If you experience any of these symptoms, particularly a fever, call your doctor.

What are the causes of pregnancy loss?

More than half, but as many as 90%, of pregnancy losses are the result of random chromosomal abnormalities that have nothing to do with your fertility status. See our article on the Causes of Miscarriage to learn more.

What do you do if you think you’re experiencing pregnancy loss?

First, call your doctor to set up an appointment. Then, check out our article Am I Having a Miscarriage?


Stillbirth: Pregnancy Loss After 20 Weeks

What is stillbirth?

The term "stillbirth" generally refers to a pregnancy loss at 20 weeks of gestation or later.

How common is stillbirth?

Stillbirth occurs in about 1 in 160 births, meaning roughly 0.625% of pregnancies will be lost after 20 weeks. There are more than 23,000 stillbirths in the United States every year. 

What are the different types of stillbirth?

  • Early stillbirth (20 to 27 completed weeks)
  • Late stillbirth (28 to 36 completed weeks)
  • Term stillbirth (≥37 completed weeks)

We include stillbirth in all of our pregnancy loss content but recognize that losing a pregnancy after 20 weeks can have a different recovery both physically and emotionally from earlier pregnancy loss, and the only treatment option may be delivering your baby. You can find more in our article Navigating Stillbirth to learn more about some of the immediate decisions you may face after experiencing a loss later into your pregnancy. 

Explore our hub on pregnancy loss here.

Bodily does not provide medical advice, diagnosis, or treatment. The resources on our website are provided for informational purposes only. You should always consult with a healthcare professional regarding any medical diagnoses or treatment options.

Sources

https://www.uptodate.com/contents/miscarriage-beyond-the-basics/abstract/1https://pubmed.ncbi.nlm.nih.gov/18310375/https://academic.oup.com/aje/article/177/11/1271/97504
https://pubmed.ncbi.nlm.nih.gov/15672031/ https://elemental.medium.com/what-to-expect-when-you-have-a-miscarriage-74114d2bb7de https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_07.pdf
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