A pregnancy test can change everything in minutes. Then a small spot on the underwear, a tugging pain low in the belly, or a sudden drop in nausea can trigger a flood of questions. If you are looking up Miscarriage, you may be hoping for two things at the same time: clear medical explanations, and a simple sense of what to do next.

You will see what Miscarriage means, how doctors confirm it, what symptoms need quick attention, why it happens, and what recovery often looks like, physically and emotionally.

Miscarriage explained: what it is and what it isn’t

A Miscarriage is the spontaneous end of a pregnancy before 20 weeks of gestation. Many happen in the first trimester (up to 12-13 weeks). In clinic notes, you may see “early pregnancy loss” or “spontaneous abortion”. These terms describe the same medical event and do not mean an induced abortion.

Early terms you may hear

Chemical pregnancy (biochemical loss): the urine or blood test is positive because hCG (human chorionic gonadotropin) is present, but the pregnancy ends before an ultrasound can confirm a pregnancy inside the uterus.
Missed miscarriage (silent miscarriage): the pregnancy stops developing, yet bleeding and cramps may not start immediately.
Anembryonic pregnancy (“blighted ovum”): a gestational sac forms, but the embryo does not develop as expected.
Molar pregnancy (hydatidiform mole): abnormal placental tissue growth. It requires uterine evacuation and follow-up because hCG can remain high.

Viability: why doctors talk about weeks

In medicine, “viability” means the point at which a fetus may survive outside the uterus with neonatal intensive care. In many settings this is around 22-24 weeks, depending on the hospital and the baby’s condition. Most Miscarriage events happen well before that.

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Miscarriage can be “silent”

A missed Miscarriage can feel especially confusing because the body may take time to respond. The pregnancy has stopped developing, but the uterus has not yet begun expelling the tissue. Often, parents learn this only during an ultrasound.

Miscarriage vs stillbirth vs ectopic pregnancy

Miscarriage: pregnancy loss before 20 weeks.
Stillbirth: fetal death after about 20 weeks (definitions vary by country and reporting rules).
Ectopic pregnancy: implantation outside the uterus, most commonly in a fallopian tube. It cannot develop safely and may cause internal bleeding. Any early pregnancy bleeding with pain, especially one-sided pain, needs assessment.

How common Miscarriage is

Among recognised pregnancies, about 10-20% end in Miscarriage. If very early losses are counted (before a missed period or before a scan), estimates rise, sometimes quoted around 30-50% of conceptions.

Why risk changes by week

The earliest weeks are a period of rapid cell division. Many early losses happen due to aneuploidy (an abnormal number of chromosomes in the embryo). As pregnancy progresses and key milestones are met, the chance of loss generally decreases.

Miscarriage chances by age (and paternal age)

Maternal age has a strong effect:

20s: roughly 12-15%
30-34: around the mid-teens
35-39: often around ~18%
40-44: around ~37%
45+: can be 60% or higher

Paternal age can contribute modestly too.

Miscarriage symptoms and warning signs

Symptoms can overlap with normal early pregnancy changes. So what should you watch? And what should you write down for your doctor?

Bleeding in early pregnancy: what to track

Spotting or light bleeding can occur and does not always mean Miscarriage. Bleeding may be brown (older blood) or bright red.

Helpful notes for your clinician:

When it started
Whether it is increasing or settling
Approximate amount (pads used and how quickly)
Any clots or tissue

Cramping, pelvic pain, or back pain

Mild cramping can happen in normal pregnancy. With Miscarriage, cramps may become stronger, persistent, or wave-like.

Contact a clinician promptly if:

Pain is sudden, very intense, or unusual
Pain is clearly one-sided (ectopic pregnancy must be excluded)
Pain continues despite the pain relief plan you were given

Passing clots or tissue, and symptom changes

Passing clots or tissue can occur during Miscarriage.

Pregnancy symptoms like nausea or breast tenderness may reduce as hCG levels fall. That change can feel alarming, but it is not diagnostic by itself.

Missed miscarriage: few or no symptoms

In missed Miscarriage, pregnancy tissue stays in the uterus and bleeding may be very light or absent. Diagnosis is often made on ultrasound.

When to seek urgent care

Seek urgent care immediately for:

Heavy bleeding (soaking more than two pads per hour for 2 hours, or a rapid soak with a continuous flow sensation)
Severe or worsening pelvic/abdominal pain
Dizziness, fainting, confusion, or feeling too weak to stand
Fever ≥38°C, chills, or foul-smelling discharge
One-sided pain with dizziness or shoulder pain (possible ectopic pregnancy)

Why Miscarriage happens

Many parents quietly ask, “Did I do something wrong?” In most early losses, the answer is no.

Chromosomal abnormalities (most common)

The most common cause of first-trimester Miscarriage is a chromosomal abnormality in the embryo, usually random and not inherited.

Implantation and very early development problems

Sometimes implantation starts and a gestational sac forms, but development stops early.

Uterus and cervix factors

Some uterine conditions can affect implantation or placental blood flow:

Septate uterus
Bicornuate uterus
Submucosal fibroids
Intrauterine adhesions (synechiae)

Cervical insufficiency is more often linked to second-trimester loss.

Health conditions and other contributors

Poorly controlled thyroid disease and uncontrolled diabetes can increase Miscarriage risk. Other factors may include PCOS (polycystic ovary syndrome), Antiphospholipid syndrome (APS), selected thrombophilias, infections, smoking, heavy alcohol use, illicit drugs, and unsafe medications in pregnancy.

What does not cause Miscarriage

Everyday stress, sex, exercise, and routine work activities do not cause Miscarriage in an otherwise healthy pregnancy.

Miscarriage risk factors

Increasing maternal age
Previous Miscarriage, recurrent pregnancy loss (two or more consecutive losses)
Smoking, alcohol, drugs
Obesity (BMI ≥30)
High caffeine intake (many guidelines suggest staying around ≤200 mg/day)
Uncontrolled thyroid dysfunction or diabetes
Autoimmune conditions, especially APS
Multiple pregnancy (twins+)
Significant fever in early pregnancy
Certain occupational exposures (solvents, pesticides, heavy metals, radiation)

Types of Miscarriage and what each one means

Threatened miscarriage: bleeding occurs, cervix is closed, ultrasound may show heartbeat.
Inevitable miscarriage: bleeding/cramping with cervical dilation.
Incomplete miscarriage: some tissue passed, some remains – retained products of conception (RPOC).
Complete miscarriage: all tissue passed, bleeding tapers.
Missed miscarriage: development stopped, tissue not yet passed.
Septic miscarriage: infection, an emergency.
Recurrent pregnancy loss: usually two or more consecutive miscarriages.

How Miscarriage is diagnosed

Ultrasound

Ultrasound looks for a gestational sac, yolk sac, embryo, and heartbeat. In very early pregnancy, a repeat scan after several days can avoid a wrong diagnosis. Transvaginal ultrasound is often the most accurate early on.

Blood tests: beta-hCG (and progesterone sometimes)

Serial beta-hCG over 48 hours helps assess whether the pregnancy is progressing. Falling or plateauing levels can suggest a nonviable pregnancy.

Excluding ectopic pregnancy and checking Rh status

If the pregnancy test is positive but no intrauterine pregnancy is seen, doctors monitor closely to exclude ectopic pregnancy.

If you are Rh-negative, your clinician may discuss Rh immune globulin after Miscarriage or uterine procedures, depending on local protocol.

Treatment options and what to expect

Options depend on gestational age, bleeding, pain, infection risk, anaemia risk, scan findings, and your preferences.

Expectant management (watchful waiting)

The body passes pregnancy tissue naturally. Bleeding and cramping can be heavier than a period and may last days to a couple of weeks. Follow-up is needed.

Medical management: misoprostol (with or without mifepristone)

Misoprostol helps the uterus contract and expel tissue, some protocols add mifepristone beforehand.

Surgical management: vacuum aspiration and D&C

Vacuum aspiration (including MVA) and D&C (dilatation and curettage) remove tissue from the uterus and usually resolve Miscarriage quickly. They may be advised for heavy bleeding, suspected infection, significant retained tissue, or when quick completion is important.

Pain relief and complications

Ibuprofen and paracetamol are commonly used unless contraindicated. Seek urgent care for heavy bleeding, fever, foul discharge, worsening pain, or fainting.

Follow-up

Follow-up may include symptom review, ultrasound, and/or hCG testing until levels return towards baseline.

After a Miscarriage: physical recovery

Bleeding commonly reduces over several days and becomes spotting within 1-2 weeks. A first period often returns in 4-6 weeks, but ovulation can happen earlier.

Pregnancy tests may stay positive for weeks because hCG can linger.

If bleeding was heavy, ask about iron support.

Emotional recovery and support

A Miscarriage can bring grief, anger, guilt, numbness, or a mix that changes from morning to evening. Partners may cope differently. If sadness or anxiety becomes persistent, sleep is severely affected, or daily functioning is slipping, professional support is worth discussing.

Trying again and future fertility

Pregnancy can occur soon after Miscarriage, sometimes within about 2 weeks. Some parents prefer to wait for one menstrual cycle. Certain situations (such as molar pregnancy) need a different timeline set by your clinician.

Preconception steps that often help: prenatal vitamin with folic acid, medication review, and optimising thyroid, diabetes, and other chronic conditions.

Most people later have a healthy pregnancy, estimates often quote around 80-90%, depending on age and medical history.

Recurrent Miscarriage: evaluation and care options

Recurrent pregnancy loss is commonly considered after two consecutive miscarriages (some definitions use three). Work-up may include uterine cavity assessment, thyroid tests (TSH), glucose/HbA1c, and APS testing. Targeted care may include low-dose aspirin plus heparin for APS, and selected uterine procedures when indicated.

Miscarriage in the second trimester

Second-trimester Miscarriage (about 13-19 weeks) is less common and more often linked to cervical, uterine, placental, or infectious factors. Doctors may discuss cervical-length monitoring, cerclage in selected cases, and progesterone in selected situations.

Reducing Miscarriage risk: what is in your control

Some causes cannot be prevented. Still, these steps support pregnancy health: stop smoking, avoid alcohol and illicit drugs, keep caffeine moderate, work towards a healthy weight, manage thyroid/diabetes before conception, and review medicines early with your doctor.

Conclusion

Bleeding, pain, and uncertainty in early pregnancy deserve medical attention, but they do not always mean Miscarriage. When a Miscarriage is confirmed, there are safe options to complete the process and careful follow-up to protect your health.

To remember

Miscarriage is common, especially in the first trimester, and is often due to chromosomal changes outside anyone’s control.
It can be silent, ultrasound may diagnose a missed Miscarriage even without bleeding.
Urgent warning signs include heavy bleeding, severe or one-sided pain, fever, fainting, or foul-smelling discharge.
Diagnosis relies on ultrasound and sometimes serial beta-hCG, while excluding ectopic pregnancy.
Management may be expectant, medical, or surgical, with follow-up to confirm completion.
Support exists. Your gynaecologist and care team can guide you, and you can download the Heloa app for personalised guidance and free child health questionnaires.

Miscarriage: symptoms, causes, diagnosis, treatment, and recovery