A positive pregnancy test can make everything feel immediate—plans, calendars, quiet excitement. Then bleeding starts, a scan looks uncertain, and the word Miscarriage suddenly sits in the middle of your day. Is it a late period or a Miscarriage? Should you wait, or go to the hospital now? In India, where care may involve your local gynaecologist, a nursing home, or a large maternity hospital, knowing what is typical—and what is not—can help.

A Miscarriage is medically common, but personally never “routine”. The body may bleed for days, hormones can drop quickly, and recovery can feel uneven.

Miscarriage: understanding what’s happening

Miscarriage definition (pregnancy loss before 20 weeks)

A Miscarriage (also called early pregnancy loss, medically, spontaneous abortion) means the pregnancy ends before 20 completed weeks. Most losses happen in the first trimester, often before 12 weeks.

Some losses are “clinical” (an intrauterine pregnancy was seen on ultrasound). Others occur so early that only hCG is positive on a test, this may be called a chemical pregnancy.

Miscarriage vs stillbirth vs ectopic pregnancy

• Miscarriage: loss before 20 weeks.
• Stillbirth: fetal death at or after 20 weeks (definitions vary).
• Ectopic pregnancy: implantation outside the uterus, usually in a fallopian tube, it can become dangerous if it ruptures.

Severe one-sided pain, shoulder-tip pain, fainting, or heavy bleeding needs urgent assessment because ectopic pregnancy can mimic Miscarriage early on.

How common miscarriage is

Among known pregnancies, about 10%–20% end in Miscarriage. If very early, unrecognised losses are included, the proportion is higher, because a chemical pregnancy can look like a delayed or heavier period.

Early bleeding: why it can be confusing

In early pregnancy, light bleeding does not automatically mean Miscarriage. The uterus becomes more vascular and the lining thickens under progesterone.

Early bleeding can also be linked to:

• cervical bleeding after intercourse or an internal exam
• a hormonal shift around the expected period date
• a small area of lining separation

When in doubt, what matters is the trend over time, plus blood tests and ultrasound when needed.

Types of miscarriage and related pregnancy losses

Threatened, inevitable, incomplete, complete, and missed miscarriage

• Threatened miscarriage: bleeding with a closed cervix, pregnancy may continue.
• Inevitable miscarriage: cervix opening with bleeding/cramps, continuation unlikely.
• Incomplete miscarriage: some tissue remains, bleeding/cramps continue.
• Complete miscarriage: uterus appears empty on ultrasound.
• Missed miscarriage: pregnancy stopped developing but tissue has not passed yet.

Septic miscarriage (infection)

A septic Miscarriage involves uterine infection. Warning signs include fever, chills, worsening pelvic/abdominal pain, and foul-smelling discharge. This needs urgent care.

Chemical pregnancy and blighted ovum

• Chemical pregnancy: hCG positive, nothing visible on ultrasound.
• Blighted ovum (anembryonic pregnancy): gestational sac forms but embryo does not develop.

Symptoms and early warning signs

Vaginal bleeding: spotting vs heavy bleeding

Spotting may be pink or brown. Bleeding is more concerning when it becomes bright red, increasing, or heavy—especially if you are soaking pads quickly.

A practical red flag: soaking two pads in one hour, especially if it repeats.

Clots and “tissue”

Clots can occur with heavy periods too. During possible Miscarriage, repeated large clots or fragments that look like tissue deserve assessment—especially if pain is increasing.

Cramping, pelvic pressure, and back pain

Mild cramps can happen in early pregnancy. In Miscarriage, cramps may intensify, come in waves, or feel stronger than a usual period, often with heavier bleeding.

Odour and discharge

Strong unpleasant smell, especially with fever or worsening pain, can suggest infection. Seek advice promptly.

When symptoms need urgent care

Seek emergency care if you have:

• heavy bleeding with dizziness, fainting, marked weakness, or a fast heartbeat
• severe one-sided abdominal pain, quickly worsening pain, or shoulder-tip pain
• fever around 38°C (100.4°F) or higher, chills, pelvic pain, or foul-smelling discharge

Causes of miscarriage

Chromosomal abnormalities

The most common cause of first-trimester Miscarriage is a random chromosomal problem in the embryo (aneuploidy). About half to two-thirds of first-trimester miscarriages are linked to chromosomal abnormalities. These changes usually occur by chance during early cell division.

Maternal health conditions

Risk can be higher with poorly controlled diabetes, thyroid disease (including iodine deficiency and thyroid autoimmunity), obesity, and autoimmune conditions such as antiphospholipid syndrome. Some infections can also contribute in specific situations.

Uterine factors

A uterine septum and some fibroids can be associated with miscarriage risk, depending on size and location.

Risk factors that can influence miscarriage risk

Age

Risk increases with age due to egg-related chromosomal changes:

• 20s: often ~12%–15%
• 30s: roughly ~14%–25%
• after 40: commonly ~33%–40%

Prior miscarriage

After one Miscarriage, the risk in the next pregnancy is slightly higher than baseline. After two or more miscarriages, evaluation is often discussed.

Lifestyle and exposures

Smoking and alcohol increase risk. Many clinicians advise caffeine around 200 mg/day. Some occupational exposures matter (solvents, heavy metals like lead/arsenic, radiation, cytotoxic drugs). Medication review is important when trying to conceive.

Pregnancy tests and diagnosis: what helps most

Urine test vs blood test

A urine test answers one question: has hCG been produced? It does not confirm normal development.

If there is bleeding with a positive test, many clinicians rely on:

• a quantitative blood β-hCG, and
• repeating it after about 48 hours to check the trend

Ultrasound

Transvaginal ultrasound confirms location (intrauterine vs ectopic) and looks for viability signs (gestational sac, yolk sac, embryo, heartbeat). Sometimes it is simply too early, and a repeat scan is advised.

Rh factor

Blood group and Rh status are checked. If you are Rh-negative, anti-D immunoglobulin may be offered depending on gestational age and management.

Treatment options

How the choice is made

Decision-making depends on medical stability, gestational age, bleeding, suspected infection, access to care, and preferences.

Completion is usually checked by symptom improvement plus ultrasound and/or β-hCG returning to nonpregnant levels.

Expectant management (natural)

The body passes tissue without medication or surgery. Bleeding and cramping can resemble a heavy period and may come in waves. Follow-up confirms completion.

Medical management (medication)

Most commonly misoprostol, sometimes with mifepristone. Bleeding and cramps often start within hours and can be heavier than a period for a few days. Side effects can include nausea, diarrhoea, chills, and brief fever. Follow-up is important to confirm the uterus is empty.

Surgical management (uterine aspiration or D&C)

Often chosen when bleeding is heavy, infection is suspected, tissue is retained, or quick completion is preferred. Mild cramping and light bleeding afterward are common. Rare risks include infection, uterine injury, and intrauterine adhesions.

Comfort measures and self-care

• Pain relief: paracetamol is commonly used, ibuprofen may help cramping if your clinician agrees.
• Use pads (not tampons) to monitor bleeding.
• A hot water bag/heating pad can ease cramps.
• Hydrate and rest, gentle movement is fine when you feel up to it.

Call a clinician if you soak more than two pads per hour for two hours, feel faint, develop fever, or have worsening pain.

Physical recovery after miscarriage

Bleeding commonly lasts 1–2 weeks, sometimes longer. A period often returns within 4–6 weeks, and the first cycle may feel different.

Ovulation can return as early as about two weeks after an early Miscarriage, so pregnancy can happen before the first period. If you want to avoid pregnancy right away, contraception matters during recovery.

hCG usually returns to nonpregnant levels (often <5 IU/L) over days to weeks.

Many clinicians advise avoiding intercourse and tampons until bleeding has stopped, commonly for 1–2 weeks, to reduce infection risk.

Emotional health after miscarriage

A Miscarriage can bring grief, irritability, anxiety about future pregnancy, or trouble concentrating. Hormonal shifts (hCG and progesterone dropping) can worsen sleep disruption and tearfulness in the first days.

Support can be practical and emotional—partner, family, friends, and your care team. Counselling or a pregnancy loss support group may help if fear becomes constant. Seek urgent help if you have thoughts of self-harm.

Recurrent miscarriage and next steps

Evaluation is commonly offered after two or more consecutive miscarriages. Tests may include uterine imaging, genetic testing, antiphospholipid antibodies, and thyroid/diabetes screening.

À retenir

• Miscarriage is pregnancy loss before 20 weeks and is common, many early losses are linked to random chromosomal changes.
• Early bleeding can be confusing, trends over time plus β-hCG and ultrasound give the clearest answers.
• Seek urgent care for heavy bleeding (including soaking two pads in one hour), dizziness/fainting, severe one-sided pain or shoulder-tip pain, fever, chills, or foul-smelling discharge.
• Management options include expectant care, medication (misoprostol ± mifepristone), or surgical care (aspiration/D&C), chosen based on safety and preference.
• Support exists, and you can download the Heloa app for personalised guidance and free child health questionnaires.

Further reading :

• Miscarriage (https://www.nhs.uk/conditions/miscarriage/)
• Miscarriage – Symptoms and causes (https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/symptoms-causes/syc-20354298)