What To Know About Missed Miscarriage

How can you have a miscarriage and not know it? Learn how a missed miscarriage can happen without the usual symptoms of pregnancy loss.

A missed miscarriage is a pregnancy loss in which the embryo or fetus has died or stopped developing, but your body hasn't recognized the loss or expelled the pregnancy tissue yet.

Missed miscarriage is also called missed abortion or silent miscarriage, and for good reason: You won't experience common miscarriage symptoms like cramping or bleeding. Instead, you'll find out you've had a miscarriage after an ultrasound reveals that there's no fetal heartbeat.

Pregnancy loss can be devastating, but rest assured that miscarriage isn't caused by anything you did. A miscarriage can happen to anyone. Here's what you need to know about missed miscarriage including symptoms, causes, and what to expect if it happens to you.

Causes of Missed Miscarriage

With a missed miscarriage, pregnancy starts off on the right foot when the fertilized egg implants in the uterus. But some time in the first trimester, usually between 6 to 10 weeks, the embryo or fetus stops developing. Experts don't know why some people experience symptoms of miscarriage soon after the baby stops developing while others don't experience symptoms for several weeks like with missed miscarriage.

Though doctors can't always pinpoint a reason for a pregnancy's failure to progress or why symptoms of miscarriage are delayed, there are some explanations for miscarriage, says Erika Nichelson, DO, a board-certified OB-GYN at the University of Pittsburgh Medical Center.

Most commonly, there's a chromosomal issue that makes the fetus incompatible with life. Genetic abnormalities are the most common cause of miscarriage. In other cases, the embryo doesn't develop and leaves behind an empty pregnancy sac (this is called an anembryonic pregnancy) or the embryo starts to grow but for some reason doesn't continue.

Missed Miscarriage Symptoms

With most types of miscarriages, you'll experience vaginal bleeding, cramping, and back or abdominal pain or cramping. With a silent miscarriage, however, you likely won't have any signs or symptoms. Brownish discharge might be present on some occasions.

Some people will experience a sudden loss of their pregnancy symptoms, such as morning sickness and breast tenderness. In other cases, people continue to experience early pregnancy symptoms after a missed miscarriage, which can make the news of the loss even more unexpected.

Diagnosing a Missed Miscarriage

The only way for your health provider to diagnose a missed miscarriage is by performing an ultrasound. But even then, most health providers are hesitant to diagnose miscarriage based on one ultrasound alone—especially in the very early days.

"Dating can be off, especially in women with longer cycles (35 to 45 days), as they would ovulate later," Dr. Nichelson explains. "The pregnancy wheel is based on a 28-day cycle with ovulation on day 14, and that's not always the case."

To gather more information, your health care provider may send you for a follow-up ultrasound that's read by a radiologist. If the radiologist doesn't detect a fetal heart rate or the embryo is much smaller than expected, that ultrasound will likely be the last one you'll receive.

Meanwhile, your health care provider will likely also do labs to check the hCG level in your blood. Human chorionic gonadotropin (hCG) is a hormone produced by the placenta, and in a viable pregnancy, the amount of hCG will double every 48 to 72 hours in the first trimester. If the level of hCG in your blood is not increasing as expected and the "official" ultrasound failed to pick up a fetal heartbeat, then your health care provider will likely diagnose a missed miscarriage.

What To Do for a Missed Miscarriage

After discovering you have experienced a missed miscarriage, you'll need to discuss next steps with your health care provider, which could include:

• Waiting: Also called expectant management, you can wait to let your body miscarry naturally. "Sometimes, people need to wrap their brain around what just happened and take some time to mourn the loss," Dr. Nichelson says. "You can wait and see if the body will figure out that the pregnancy isn't good. Most of the time—though not always—the bleeding and cramping of the miscarriage will start on its own."

• Medication: Hastening the miscarriage with medicine is another option. If you'd prefer not to wait, your doctor can give you misoprostol, which will help the uterus contract and expel the pregnancy tissue at home.

• Medical procedure: You may also opt to have a procedure known as a dilation and curettage (D&C). If you're further along (think 12 weeks or more) then the fetus may be harder to pass and your doctor may want to perform a D&C, says Dr. Nichelson. This procedure removes the fetal tissue from the uterus.

Will a Missed Miscarriage Affect Future Pregnancies?

Though trying to conceive may be the furthest thing on your mind after a missed miscarriage, you can try again with your next cycle if you passed the pregnancy on your own or with Cytotec (misoprostol). If you underwent a D&C, on the other hand, your health care provider may advise that you wait several cycles before trying again, to give your body time to heal.

And if you do get pregnant again after miscarriage, don't be surprised if you're feeling extra nervous the next time around. Dr. Nichelson says patients often have a fear of coming into the office for those early ultrasounds. But there's good news: "Most commonly, a missed miscarriage doesn't happen the second time."

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