Pregnancy requires substantial physical and emotional labor, even before you give birth. Despite all that hard work, not all pregnancies end in healthy babies. Especially in the first trimester of pregnancy, early miscarriages are common. About 10% to 20% of women who learn they are pregnant will have an early miscarriage. Miscarriages can be taxing on the body and mind and, for some, discouraging. If you experience a miscarriage, it’s important to remember that this experience is not your fault — and that your body deserves love and care with or without a growing baby.
Below, learn about how to respond to symptoms and signs of early miscarriage should they occur.
[READ: What Is TFMR? Termination of Pregnancy for Medical Reasons.]
What Is an Early Miscarriage?
Dr. G. Thomas Ruiz, an OB-GYN Lead at MemorialCare Orange Coast Medical Center in Fountain Valley, California, says that the exact definition of an “early” miscarriage may vary from practice to practice. While some providers may consider losing a pregnancy at six weeks or earlier to be an early miscarriage, others may extend that category to eight weeks or longer. A first-trimester miscarriage, which is when most miscarriages occur, refers to any miscarriage before 13 weeks of pregnancy.
Depending on how early in pregnancy their miscarriage occurs, a person may not feel symptoms of the miscarriage. Additionally, people can sometimes experience a miscarriage without having known they were pregnant.
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Common Miscarriage Symptoms
It can be difficult to confirm a miscarriage at home, so doctors recommend contacting your health care provider if you suspect you are experiencing one. Educating yourself on common miscarriage symptoms can prepare you to pick up the phone should warning signs occur.
Common miscarriage symptoms include:
— Vaginal bleeding. When pregnant, you stop having a period — so any bleeding during pregnancy can be a warning sign that something is wrong. However, some people with healthy pregnancies may also experience spotting early on. If bleeding grows heavier or does not stop, it is a good idea to call your doctor.
— Cramping and pain in the lower abdomen. You may experience cramping and pain in your lower abdomen, above the uterus, if you are having a miscarriage. These can range in intensity, often feeling like painful period cramps and sometimes feeling similar to labor contractions. Sensations may last a few hours, or the duration that you are bleeding.
— Discharge of fluid or tissue from the vagina. Discharge of fluid or tissue from the vagina may indicate that you are actively passing a miscarriage and your body is flushing out any parts of the pregnancy that have started to grow.
— Absence of typical pregnancy symptoms like nausea and breast tenderness. A miscarriage effectively ends your pregnancy. As a result, your pregnancy symptoms may decrease in intensity or go away. This may take longer for some people than others.
Ruiz encourages patients not to be shy in reaching out to their doctor if experiencing any of the above symptoms.
Not only can your doctor evaluate whether or not you are having a miscarriage, they can also ensure you are receiving the right care for your situation. This is important because different kinds of miscarriages require different types of interventions. Further, dangerous conditions — like ectopic pregnancies — can be mistaken for miscarriages and require quick and unique treatment.
Types of miscarriages: complete vs. incomplete
After your body completes a miscarriage, the uterus should be empty of any fetal growth or tissue — hence the heavy bleeding and cramping that can occur. In some cases, however, your body may not remove all the remnants of your pregnancy and you may have experienced an incomplete miscarriage.
Incomplete miscarriages often require you to undergo a procedural or medication treatment to help your body flush out leftover tissue and avoid risks of infection. Procedural options include a surgery called dilation and curettage, or D&C, where the doctor will use instruments to remove leftover tissue from your body. Medication options include taking an oral dose of mifepristone followed by misoprostol, the two pills that are together referred to as the abortion pill.
If you are experiencing an incomplete miscarriage, you will likely be alerted of your situation due to heavy bleeding and cramping — and even the passing of some tissue out of your body. After you seek medical attention, your doctor will be able to confirm whether or not your miscarriage is complete or incomplete.
Risks of incomplete miscarriages are less common before week six of pregnancy, as fetal growth is likely minimal.
Ectopic pregnancy
Some symptoms of an early miscarriage, like vaginal bleeding, can overlap with those of an ectopic pregnancy. Ectopic pregnancies are pregnancies that implant outside of the uterus, usually in the fallopian tube. Ectopic pregnancies can be extremely dangerous and life-threatening to the mother.
“If you’re in early pregnancy and you start spotting, you should seek early prenatal care — if anything — to determine the location of the pregnancy,” Ruiz adds, even if you don’t think you’re at risk for a miscarriage. “Early spotting, which may not be very much, is sometimes the first symptom of an ectopic pregnancy.”
Ectopic pregnancies cannot yield a healthy birth and can increase the risks of death for the mother — especially if they are caught late. If an ectopic pregnancy grows too large in the fallopian tube, the tube can rupture and the mother is vulnerable to bleeding to death.
In addition to bleeding, some other warning signs of an ectopic pregnancy include:
— Severe abdominal pain.
— Shoulder tip pain.
— Diarrhea.
— Vomiting.
— Feeling faint.
It is important to seek immediate medical attention if you experience any of these symptoms. Some of these symptoms, such as feeling faint and pain in the shoulder may indicate that you not only are experiencing an ectopic pregnancy but that the fallopian tube has ruptured and you are experiencing a medical emergency.
[READ: Pregnancy After Miscarriage.]
Early Symptoms of Miscarriage by Week
Most miscarriages are early miscarriages, with 80% of miscarriages occurring before week 12. Symptoms of early miscarriages — except missed miscarriages, which often do not produce symptoms — tend to be the same throughout the first trimester with some variations in intensity. For instance, a miscarriage at week two of a pregnancy may yield less bleeding or cramping than a miscarriage at week 12, due to how much the fetus has developed.
Early miscarriage symptoms at 2 weeks to 4 weeks
At two to four weeks into pregnancy, or after your last menstrual period, symptoms may look like light to heavy vaginal bleeding and mild cramping or discomfort.
“Miscarriages two weeks up through four weeks post (the person’s) last menstrual period are pretty similar,” Ruiz says. “Some patients may not even realize they’re pregnant yet and just think that their menses was late. It presents a lot like a very heavy period.”
Signs of miscarriage at 6 weeks
At six weeks into a pregnancy, a miscarriage may be more noticeable. By this time, you are likely aware that you are pregnant and may have begun to feel more telltale symptoms of pregnancy like mild nausea and breast tenderness, Ruiz says. A miscarriage will therefore incur a noticeable shift in how you are feeling in your body, he adds.
“All of a sudden those symptoms will stop if the pregnancy becomes non-viable because the hormones of pregnancy have started to decrease,” Ruiz says.
Additionally, you may experience symptoms like:
— Heavier cramping.
— Heavy bleeding, which may include passing of large clots.
— Potential passing of tissue in an identifiable sack.
Miscarriage symptoms at 8 weeks
If you are experiencing a miscarriage at eight weeks into your pregnancy, you will likely experience similar symptoms to those that you may have experienced at week six — but with more intensity and with higher risks of an incomplete miscarriage. Despite higher risks of incomplete miscarriages now than in previous weeks, it is still more likely that you will have a complete miscarriage, Ruiz says.
“Most women between eight to 10 weeks gestation will still pass all of the tissue,” Ruiz says. “But I have seen instances where patients will have light spotting with intermittent heavy bleeding for up to a month.”
Some miscarriage symptoms at eight weeks include:
— Heavy cramping.
— Heavy bleeding, which may include the passing of large clots.
— Passing of tissue in an identifiable sack.
— Higher probability of not passing all tissue.
— Higher probability of prolonged bleeding — which can last for one to two weeks depending on how much tissue has remained.
Miscarriage symptoms at 10 weeks
If you are experiencing a miscarriage at week 10 into your pregnancy, you will likely experience similar but more intense symptoms than are expected at week eight. These can include:
— Heavy cramping.
— Heavy bleeding, which may include the passing of large clots.
— Passing of tissue in an identifiable sack.
— Higher probability of not passing all tissue.
— Higher probability of prolonged bleeding — which can last for one to two weeks depending on how much tissue has remained.
— Higher risks of hemorrhages and infections.
Medical care is especially important at this stage, as it is likely that you will need to undergo a D&C operation or use medication to empty the uterus and prevent infection, Ruiz says.
How to Diagnose a Miscarriage
To confirm whether or not you are experiencing — or have experienced — a miscarriage, your doctor will likely conduct two tests. These include a blood test to evaluate your beta-hCG levels and an ultrasound to look at the pregnancy.
— Blood tests to evaluate your beta-hCG levels. Beta-hCG, which stands for beta-human chorionic gonadotropin, is a hormone made by the placenta. In a healthy pregnancy, beta-hCG levels should double every 48 hours. By taking more than one blood test, about 48 hours apart, doctors can assess if this is happening. If it isn’t — and you were previously pregnant — it is a signal that you may have lost your pregnancy.
— An ultrasound scan to visualize the pregnancy. An ultrasound will look at your uterus to see if there is or isn’t a developing fetus, as well as look for lingering tissue.
How to diagnose an ectopic pregnancy
An ectopic pregnancy can be diagnosed through the same diagnostic tools used to assess a miscarriage. These tests can indicate an ectopic pregnancy if beta-hCG levels are elevated to or above 2000, and the ultrasound does not reveal an intrauterine pregnancy. The type of ultrasound used is typically a vaginal probe ultrasound.
Symptoms of missed miscarriages
Some people who experience an early miscarriage do not produce symptoms like heavy bleeding or cramping. Instead, the miscarriage may not be detected until a prenatal check-up visit. In such cases, a person may be experiencing a missed miscarriage, also known as a missed abortion.
Some signs of a missed miscarriage include:
— An ultrasound shows that the fetus has not grown since your last check-up.
— An ultrasound shows that the fetus is not moving.
— An ultrasound shows a decrease in the size of the uterus.
— No heartbeat is detected.
Some people who experience missed miscarriages may experience light bleeding or discharge, but this is not always the case.
Additionally, some people may notice that some of the hormonal symptoms they were previously experiencing during pregnancy have subsided — but this is not always the case, either. Pregnancy hormones can continue to be high for some time after you have miscarried.
When to seek medical attention
Since a missed miscarriage can occur in silence, people can’t typically rely on symptom cues for when to seek medical attention. For all pregnant people, it’s smart to be in close contact with your medical provider and attend your regular prenatal check-ups so that your doctor can detect any health issues with you or your developing baby.
Additionally, if you do notice miscarriage symptoms like bleeding, cramping, or changes in hormonal activity, you may want to give your doctor a call.
What Causes Miscarriages?
There are many reasons why a pregnancy may not yield a healthy baby — and early miscarriages can happen to anyone.
Dr. Maria Sophocles, a board-certified OB-GYN at Women’s Healthcare of Princeton in Princeton, New Jersey, explains that all healthy pregnancies require a “melding and a blending of genetic material,” which has to occur exactly right to eventually produce a baby. When genetic material doesn’t blend just right, it can produce chromosomal abnormalities that increase risks of miscarriages. These refer to major differences in chromosome numbers and which are not related to chromosomal conditions like Down syndrome.
In addition to chromosomal abnormalities, a pregnant person may have structural abnormalities to the uterus, which can make it harder for them to get pregnant or increase their risk of miscarriages. One common structural abnormality is the appearance of uterine fibroids. Fibroids are growths in the uterus which are typically non-cancerous.
When someone is not pregnant, fibroids can cause pain or discomfort or heavy bleeding, or for some people no symptoms. When someone is pregnant, fibroids can complicate the pregnancy by taking up space in the uterus that the growing fetus would otherwise occupy. Sophocles compares the uterus to “an empty room with no furniture,” providing space for the developing baby — or babies — to grow. Fibroids are “like big chairs in the room,” making it harder for the baby to grow.
Some other factors may increase your risk of having a miscarriage, including:
— Smoking cigarettes.
— Drinking alcohol during pregnancy.
— Drinking excessive caffeine — more than 300 milligrams daily — during pregnancy.
— Unmanaged conditions, like high blood pressure.
— Some hormone conditions, like polycystic ovary syndrome, or PCOS.
— Some diseases, like HIV.
— Your weight: being over- or underweight may increase your risk for a miscarriage.
— Your age: being an older parent may increase your risk for a miscarriage.
What Happens After a Miscarriage
Many people recover naturally after a miscarriage and can get back to normal physical activity within two days, according to the American College of Obstetricians and Gynecologists. You may experience some tenderness and bleeding in the aftermath — and spotting can last for a few weeks. ACOG advises not to put anything in your vagina, such as a tampon or penis, and to call your doctor if you experience heavy bleeding. Heavy bleeding may indicate an infection.
You may also experience emotional symptoms after a miscarriage, which can be different from person to person. Reminding yourself that the miscarriage is not your fault and talking about your feelings with people you trust may help.
Bottom Line
Doctors recommend seeking medical attention if you are experiencing spotting, heavy bleeding, cramping, abdominal pain or unexpected hormonal changes during pregnancy. It’s also important to seek immediate medical care if you experience unexpected pain in the shoulder or lightheadedness, as these are signs that you may be experiencing an ectopic pregnancy — a medical emergency.
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Early Signs of Miscarriage: Symptoms to Watch For originally appeared on usnews.com
