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How to Spot the Symptoms of Miscarriage at Every Stage of Pregnancy

Miscarriage can occur at any point in the first 20 weeks of pregnancy.


By Leah Groth, Prevention

Miscarriage remains a highly sensitive topic that many Americans avoid talking about—but more women than you may think experience early pregnancy loss, often leaving them with intense emotional and physical symptoms of grief.

Among women who know they are pregnant, roughly 10 to 15 percent experience a miscarriage. However, it's estimated that the actual miscarriage rate may be significantly higher—up to 50 percent, according to March of Dimes, a nonprofit organization that focuses on reducing premature births in the United States. This is due to the fact that many women miscarry before even realizing they're pregnant.

But why does a miscarriage even happen—and are the symptoms always obvious? Here's what you should know.


What causes a miscarriage?

A miscarriage is a pregnancy loss that occurs on its own within the first 20 weeks of gestation. While doctors are sometimes unable to explain why a miscarriage occurs, about half of miscarriages result from an abnormal number of chromosomes in an embryo.

"Reproduction is not flawless, and nature seeks to eliminate imperfect developing embryos," says Felice Gersh, MD, an obstetrician-gynecologist and director of the Integrative Medical Group of Irvine. Other potential causes can stem from problems with the uterus or cervix (such as large uterine fibroids, for example), or infections like sexually transmitted diseases.

Some women are at a greater risk for miscarrying than others, including those who are older than 35, have a history of two or more miscarriages, use drugs or alcohol, smoke cigarettes, or have been exposed to harmful chemicals.

If you've experienced a miscarriage, it's important to understand that it was in no way your fault, and it's likely that your next pregnancy will go well, explains Dr. Gersh. However, you should definitely seek professional counseling if you're experiencing intense grief. "Having a miscarriage is very emotionally impactful," she says. "But please know things most likely will get better."


Miscarriage symptoms

If you experience any of the symptoms of miscarriage, see your doctor, who can help stop the bleeding and prevent infection.


Weeks 2 through 4

In the first few weeks after conception, most women won’t even know they're pregnant, as only a very sensitive pregnancy test will detect a pregnancy so early. A miscarriage during this early period is often referred to as a chemical pregnancy and sometimes goes unnoticed. Chemical pregnancies are often mistaken for a regular menstrual cycle that may arrive earlier or later than expected, with similar bleeding and cramping.


Weeks 4 through 12

Through the first trimester of pregnancy, the symptoms of miscarriage remain the same. "The most typical symptom of impending miscarriage is some degree of bleeding—which can vary from light spotting to heavy bleeding," Dr. Gersh explains. The color of the blood can be brownish, pink, or bright or dark red, and can include some clots. The heavier the bleeding, the more likely it is that a miscarriage has occurred.

You may also feel cramping in your abdominal or pelvic region, as well as a lower back ache. "The degree of discomfort can vary from minimal to quite severe during the actual miscarriage,” says Dr. Gersh, noting that pain can also radiate down the upper legs.

The severity of the bleeding and cramps can sometimes (but not always) correlate with the duration of the pregnancy. "Think of it this way: the more tissue that's built up in the uterus, the more that must be removed," she explains. Hence, there will be more bleeding and cramping as the pregnancy progresses.

After a miscarriage, you may notice that any pregnancy symptoms you've been experiencing—breast tenderness, fatigue, nausea, and more—will disappear once a miscarriage occurs. “If nausea and breast tenderness disappear, that could signify that pregnancy hormone levels are dropping, though this is a very soft sign and without bleeding or cramping, I wouldn’t get too concerned,” says Dr. Gersh. However, she does reiterate that getting checked out is always wise.


Weeks 12 through 20

Once you've entered your second trimester, miscarriage symptoms can include pelvic pressure and mucous discharge; otherwise the main symptoms to look for are still bleeding and cramping.


Types of miscarriage

There are many different ways for a miscarriage to happen, and nearly all types of miscarriage have the same symptoms listed above. This includes:
  • Blighted ovum: This refers to a fertilized egg that never developed into an embryo.
  • Recurrent miscarriage: When a woman has multiple miscarriages, they're described as recurrent miscarriages and often require medical testing to uncover the underlying cause.
  • Threatened miscarriage: This common condition causes miscarriage symptoms like abnormal bleeding and pain, but may not actually result in pregnancy loss, according to Dr. Gersh. While the pregnancy is considered a "threatened miscarriage," many of these cases successfully carry to full term with the proper care.

Do these symptoms always point to a miscarriage?

Not necessarily, here are two exceptions to be aware of:

Ectopic (or tubal) pregnancy

This refers to a pregnancy where a fertilized egg implants anywhere outside the womb—usually a fallopian tube, but sometimes on the ovaries, in the cervix, on the liver, or by the bowel. These pregnancies are rarely successful and usually cause internal ruptures, which lead to vaginal bleeding, extreme cramping, dizziness, and fainting. An ectopic pregnancy is a very serious, potentially life-threatening condition and one of the most common causes of maternal mortality. The symptoms can be quite similar to a normal miscarriage, so be sure to contact your doctor if you experience them.


Molar pregnancy

A molar pregnancy occurs when tissue in the uterus develops into a tumor. The placenta doesn't develop properly; instead, that tissue grows into a mass of cysts that grows in a chaotic manner and fills the uterus until heavy bleeding occurs. The symptoms may also include nausea and grape-like cysts that pass through from the vagina. An ultrasound can detect a molar pregnancy, so they rarely grow very large before being surgically extracted. A molar pregnancy almost always results in pregnancy loss, although many women who experience one are able to have a successful pregnancy later on.

The bottom line: Miscarriages are more common than many people realize, and while they can be extremely upsetting, they are never a woman's fault. While pregnant, it's important to pay close attention to your body and alert your doctor to any pain or bleeding. Despite having a miscarriage, many women go on to have healthy, successful pregnancies in the future.


See more at: Prevention

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