A missed miscarriage can happen for a variety of reasons—here’s what it is, the symptoms and the causes

One of the most challenging things about pregnancy loss is that every individual’s experience is difficult, unique and unexpected. While there are various types of miscarriage, what is referred to as a “missed miscarriage” is one of the most common types of early pregnancy loss. 

As a fertility specialist who has worked in the field of reproductive endocrinology and infertility for over two decades, I have cared for countless patients with pregnancy losses. Often, patients come to me after experiencing multiple miscarriages, desperately searching for an underlying cause or a path forward with family building.

What is a missed miscarriage?

Missed miscarriage is the term used when an embryo has stopped developing, but the body has not yet recognized the pregnancy loss or begun to expel the pregnancy tissue on its own. The placental cells continue to release hormones, which leads some patients to continue experiencing regular symptoms of pregnancy, even though the pregnancy/embryo is no longer viable.

To better understand this common type of pregnancy loss, let’s talk about the possible causes and symptoms of a missed miscarriage, what treatment options are available and what your next steps might look like.

Symptoms of missed miscarriage

While many people think of cramping and bleeding as typical symptoms of pregnancy loss, a missed miscarriage frequently occurs without obvious signs such as bleeding, lower abdominal cramping or back pain. 

This is why it is also sometimes referred to as a silent miscarriage, missed abortion or blighted ovum. Although you may not experience any symptoms, some people might notice:

• Abdominal cramping
• Brownish-pink or red vaginal discharge

However, most often, a missed miscarriage is only discovered during an ultrasound at a fertility clinic or an early OB-GYN prenatal visit. This is usually due to a combination of continued pregnancy symptoms (as hormone levels remain high) and the fact that these losses occur so early on in pregnancy, before other physical signs of pregnancy have appeared.

A pregnancy test may continue to show a positive result until those hormone levels finally drop, even after a fetus has stopped developing. This can be confusing and difficult to process, especially after you have a confirmed missed miscarriage.

Possible causes of missed miscarriage

The reality is that greater than 50% of missed miscarriages occur for an unknown reason. The cause could be something related to the uterine cavity, such as fibroids or scar tissue, or it could be something related to the embryo itself, whether that involves chromosomes or deeper genetic issues.

Furthermore, there could be physical or environmental issues that were in play. This could include an untreated medical condition, like an infection, or as a result of significant heavy metal exposure, like lead.

Some patients choose to have a dilation and curettage (also called a D&C) to have genetic testing performed on the fetal tissue to try and determine a reason the pregnancy came to such an abrupt end. This type of testing can sometimes reveal a clear cause for the miscarriage (such as genetic abnormalities). However, sometimes it does not reveal any genetic abnormalities and points you and your provider down a different diagnostic pathway. 

Genetic abnormalities in the fetus are often what lead to pregnancy loss and become increasingly common as women age. Structural issues with the uterus or cervix or other health problems, such as uncontrolled thyroid disease or diabetes, can also lead to miscarriage.

Early implantation is a vascular process and sometimes bleeding between the placental cells and the uterine wall (known as subchorionic bleeding) can be the cause of a pregnancy loss after the initial implantation has started.

Blood work and diagnostic tests (such as a saline sonohysterogram, which examines the structure and health of the uterus) can be performed to help identify or rule out these underlying issues. If you’re working with a reproductive endocrinologist at a fertility clinic, diagnostic tests like these are typically performed prior to beginning a treatment cycle to give you the best chances of success. 

Diagnosing a missed miscarriage

When a missed miscarriage occurs, ultrasound imaging will typically show an empty pregnancy sac without any embryonic tissue, also known as a blighted ovum or an embryonic gestation. Alternatively, the embryo may be visible in the amniotic sac but appear smaller than expected and have no heartbeat.

What are the treatment options for missed miscarriage?

It can take several days (or even weeks) for a physical miscarriage to occur once a person has been diagnosed with a missed miscarriage. Depending on a few different factors, such as how far along in the pregnancy you are and what your personal preferences may be, the treatment options for a missed miscarriage can include:

• Allowing the miscarriage to occur on its own without medical intervention.
• Taking medication to bring on uterine contractions, which induces the miscarriage process. One of the medications used is called misoprostol, which can be administered orally or vaginally.
• A surgical procedure, such as a dilation and curettage (D&C) to remove fetal tissue.

If you are experiencing heavy, uncontrolled bleeding or are at risk of infection, your healthcare provider may suggest medical or surgical treatment in order to keep you safe.

A note on reproductive autonomy

With the U.S. Supreme Court’s 2022 decision to overturn Roe v. Wade, essential reproductive healthcare (such as the treatment of missed miscarriages) is now in jeopardy throughout the United States. 

As individual states continue to introduce legislation that could prohibit or criminalize access to life-saving treatments like misoprostol, which is used in a medication abortion, or dilation and curettage (D&C) procedures, it has become clear that these actions do not only impact those seeking abortions. They also impact those who are in desperate need of access to these treatments for other reasons. 

Regardless of your beliefs, understanding the importance of maintaining accessibility to reproductive healthcare is paramount.

Related: What overturning Roe v. Wade could mean for those who experience missed miscarriage and pregnancy loss

Coping after pregnancy loss

While over 25% of all pregnancies end in pregnancy loss, the combination of shame, heartache and stigma around miscarriage continues to lead many to believe they are alone in this painful experience. 

If you feel able to share your feelings with a trusted friend, family member or counselor, it can be a helpful way to process loss.

Though it may be difficult to accept, it is important to remember that in almost all cases, there is nothing you could have done differently to avoid the unexpected end of your pregnancy. You did not cause your loss.

As you begin to heal and look toward the future, know that the odds are in your favor. When you feel ready to try to conceive again, keep these facts in mind:

• Most people who experience an early pregnancy loss can conceive again and have a successful pregnancy.
• Approximately 65% of women who experience unexplained recurrent pregnancy loss (two or more miscarriages) go on to have a successful next pregnancy, according to The American College of Obstetricians and Gynecologists (ACOG).
• Upwards of 80% of miscarriages occur in the first trimester, which means that once you pass 12 weeks gestation, your chances of losing the pregnancy decrease drastically. Miscarriage in the second trimester (between 13 and 19 weeks) happens in 1% to 5% of pregnancies.

If you think you may be experiencing a miscarriage or have any concerns, don’t hesitate to reach out to your fertility clinic or OB-GYN. And as challenging as it can be, try to trust that you will be able to have a healthy, successful pregnancy in the future. You are not alone. Stay hopeful and take time to self-educate, get support and heal.