Miscarriage without pain or clots

Miscarriage | Warning Signs, Myths, Symptoms and Causes

Many women experience some bleeding in early pregnancy. About 1 in 5 recognised pregnancies end in miscarriage. Most are caused by a one-off fault in the genes. Always tell your doctor if you have vaginal bleeding when you are pregnant. Call an ambulance if the bleeding is very heavy or if you have severe tummy (abdominal) pain. Bleeding with pain can also be a sign of an ectopic pregnancy. This is less common than miscarriage but is serious and needs urgent medical care. Losing a pregnancy can be hard for both partners. However, most couples who experience this will go on to have a successful pregnancy next time.

What causes bleeding in early pregnancy?

What is a miscarriage?

Many women may have a small amount of bleeding (spotting) at the time of their missed period. This is sometimes called an 'implantation bleed'. It happens when the fertilised egg implants itself in the wall of your womb (uterus). It is harmless.

The most common cause of bleeding after the time of the missed period is miscarriage. Miscarriage is the loss of a pregnancy at any time up to the 24th week. A loss after this time is called a stillbirth. At least 8 miscarriages out of 10 actually occur before 13 weeks of pregnancy. These are called early miscarriages. A late miscarriage is one that happens from 13 weeks to 24 weeks of pregnancy.

A less common cause of bleeding in pregnancy is an ectopic pregnancy. This is a pregnancy that occurs outside the womb. It occurs in about 1 in 100 pregnancies.

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How common is miscarriage?

Miscarriage accounts for over 40,000 hospital admissions in the UK each year. About 1 in 4 recognised pregnancies end in miscarriage. Far more pregnancies than this do not make it - as many as half. This is because in many cases a very early pregnancy ends before you miss a period and before you are even aware that you are pregnant.

The vast majority of women who miscarry go on to have a successful pregnancy next time. Recurrent miscarriages (three or more miscarriages in a row) occur in about 1 in 100 women.

What causes miscarriage?

It is thought that most early miscarriages are caused by a one-off problem with the chromosomes of the developing baby (fetus) in the womb. Chromosomes are the structures that contain the genetic information that we inherit from our parents. If a baby (fetus) doesn't have the correct chromosomes it can't develop properly and so the pregnancy will end. This is usually a one-off mistake and rarely occurs again. Such genetic mistakes become more common when the mother is older - that is, over 35 years old. This means women aged over 35 years who are having children are more likely to have a miscarriage. This may also be why, if your partner is aged over 45 years, you are more likely to have a miscarriage, even if you are under 35 years old.

You are also at a greater risk of having a miscarriage if you:

• Smoke. The risk increases the more cigarettes you smoke.
• Drink too much alcohol. Even drinking four units of alcohol a week (one unit is half a pint of beer or a small glass of wine) has been shown to increase the risk of miscarriage.
• Use recreational drugs.
• Have had fertility problems or it has taken a long time to conceive.
• Have any abnormalities of your womb (uterus) or a weakness of the neck of your womb (the cervix).
• Have certain medical conditions (for example, systemic lupus erythematosus, antiphospholipid syndrome).
• Have diabetes mellitus that is not well controlled.
• Have particular infections like listeria and German measles (rubella).

Investigations into the cause of a miscarriage are not usually carried out unless you have three or more miscarriages in a row. This is because most women who miscarry will not miscarry again. Even two miscarriages are more likely to be due to chance than to some underlying cause. Even after three miscarriages in a row, more than seven women out of every ten will not have a miscarriage next time around.

Some myths about the cause of miscarriage

After a miscarriage it is common to feel guilty and to blame the miscarriage on something you have done, or failed to do. This is almost always not the case. In particular, miscarriage is not caused by lifting, straining, working too hard, constipation, straining at the toilet, sex, eating spicy foods or taking normal exercise.

There is also no proof that waiting for a certain length of time after a miscarriage improves your chances of having a healthy pregnancy next time.

What is a threatened miscarriage?

It is common to have some light vaginal bleeding at some point in the first 12 weeks of pregnancy. This does not always mean that you are going to miscarry. Often the bleeding settles and the developing infant is healthy. This is called a threatened miscarriage. You do not usually have pain with a threatened miscarriage. If the pregnancy continues, there is no harm done to the baby.

In some cases, a threatened miscarriage progresses to a miscarriage.

What are the symptoms of miscarriage?

The usual symptoms of miscarriage are vaginal bleeding and lower tummy (abdominal) cramps. You may then pass something from the vagina, which often looks like a blood clot or clots. In many cases, the bleeding then gradually settles. The time it takes for the bleeding to settle varies. It is usually a few days but can last two weeks or more. For most women, the bleeding is heavy with clots but not severe - it is more like a heavy period. However, the bleeding can be extremely heavy in some cases.

In some cases of miscarriage, there are no symptoms. The baby stops developing or dies but it remains in the womb. You may have no pain or bleeding. You may no longer experience symptoms to suggest you are pregnant (for example, morning sickness or breast tenderness). This type of miscarriage may not be found until you have a routine ultrasound scan. This may be referred to by doctors as a missed miscarriage (also called early fetal demise, an empty sac or a blighted ovum).

The typical pain with a miscarriage is crampy lower tummy pain. If you have severe, sharp, or one-sided tummy pain, this may suggest ectopic pregnancy. This is a pregnancy that develops outside the womb. The symptoms of an ectopic pregnancy usually occur at around 6-8 weeks of pregnancy. There may be very little blood lost, or the blood may look almost black. Other symptoms may also occur such as diarrhoea, feeling faint and pain when you open your bowels. Sometimes there are no symptoms until you collapse because of heavy bleeding into the inside of your tummy (internal bleeding). This is called a ruptured ectopic pregnancy and is a potentially life-threatening situation that needs emergency surgery. You should call an ambulance or go to your nearest Accident and Emergency department if you are worried that you may have an ectopic pregnancy.

Do I need to go to hospital?

You should always report any bleeding in pregnancy to your doctor. It is important to get the correct diagnosis, as miscarriage is not the only cause of vaginal bleeding. However, if you are bleeding very heavily or have severe tummy (abdominal) pain when you are pregnant, call for an ambulance immediately.

Editor's note

Dr Sarah Jarvis, November 27th 2021

NICE guidance on miscarriage
The National Institute for Health and Care Excellence (NICE) has updated its recommendations on investigations and treatments in miscarriage. Your doctor will use this guidance to advise on next steps.

The first recommendation is for women who:

• Have a threatened miscarriage; and
• Have had an ultrasound scan which confirms the baby's heartbeat; and
• Have never had a miscarriage before.

If this applies to you, the new guidance recommends that you may not need to be referred straightaway for a scan. However, if your bleeding gets worse or goes on for at least two weeks, you should contact your doctor again. If your bleeding stops, you can continue routine antenatal care.

If you have a scan to confirm your pregnancy but have had a previous miscarriage, you should be offered vaginal progesterone pessaries to use until you have completed 16 weeks of pregnancy.

Most women with bleeding in early pregnancy are seen by a doctor who specialises in pregnancy - an obstetrician. This is often in an Early Pregnancy Assessment Unit at your local hospital. It is usual to have an ultrasound scan. This is usually done by inserting a small probe inside your vagina. This helps to determine whether the bleeding is due to:

• A threatened miscarriage (a heartbeat will be seen inside the womb (uterus)).
• A miscarriage (no heartbeat is seen).
• Some other cause of bleeding (such as an ectopic pregnancy - see above).

If it is unclear from your ultrasound scan whether the pregnancy is healthy or not then you may be asked to return for a repeat scan in one to two weeks.

The usual symptoms of miscarriage are vaginal bleeding and lower tummy (abdominal) cramps

Do I need any treatment?

Once the cause of bleeding is known, your doctor will advise on your treatment options.

Natural or expectant management

Many women now opt to 'let nature take its course'. This is called expectant management. In most cases the remains of your pregnancy are passed out naturally and the bleeding will stop within a few days after this, although can take up to 14 days to occur. However, if your bleeding worsens and becomes heavier or does not settle then you may be offered alternative treatment. Expectant management may not be offered if you have had a miscarriage in the past or if you have a bleeding disorder or any evidence of infection. You may decide that you would prefer to have a definitive treatment rather than taking this approach.

If your bleeding and pain settle then you should perform a pregnancy test after three weeks. If this is positive then you will need to see your doctor for an assessment.

Treatment with medicines

In some cases you may be offered what doctors call medical treatment for your miscarriage. That is, you may be offered a tablet to take either by mouth or to insert into your vagina. The medicine helps to empty your womb (uterus) and can have the same effect as an operation. You do not usually need to be admitted to hospital for this. Some women experience quite severe tummy (abdominal) cramps with this treatment.

You may continue to bleed for up to three weeks when medical treatment is used. However, the bleeding should not be too heavy. Many women prefer this treatment because it usually means that they do not need to be admitted to hospital and do not need an operation.

You should perform a pregnancy test three weeks after receiving medical treatment. If this is positive then you will need to see your doctor for an assessment.

An operation may be offered to you, however, if the bleeding does not stop within a few days, or if the bleeding is severe.

Treatment with an operation

If the options above are not suitable or are not successful then it is likely you will be offered an operation. The operation most commonly performed to remove the remains of your pregnancy is called surgical management of miscarriage (SMM). In this operation, the neck of your womb (the cervix) is gently opened and a narrow suction tube is placed into your womb to remove the remains of your pregnancy. This operation takes around 10 minutes.

This may be performed without the need for a general anaesthetic in some cases. This is called a manual vacuum aspiration (MVA). Your doctor will be able to discuss the procedure in more detail with you.

A few women develop an infection after having this operation. If you experience a high temperature (fever), any offensive-smelling vaginal discharge or abdominal pains then you should see a doctor promptly. Any infection is usually treated successfully with antibiotics.

Feelings

Many women and their partners find that miscarriage is distressing. Feelings of shock, grief, depression, guilt, loss and anger are common.

It is best not to bottle up feelings but to discuss them as fully as possible with your partner, friends, a doctor or midwife, or anyone else who can listen and understand. As time goes on, the sense of loss usually becomes less. However, the time this takes varies greatly. Pangs of grief sometimes recur out of the blue. The time when the baby was due to be born may be particularly sad.

Miscarriage without bleeding: Symptoms and diagnosis

Most of the time, bleeding is the first sign of a miscarriage. However, a miscarriage can occur without bleeding, or other symptoms may appear first.

Many women prefer the term pregnancy loss to miscarriage. Pregnancy loss is most common within the first weeks of pregnancy, and the risk steadily declines as the pregnancy progresses.

It is important to remember that pregnancy symptoms shift over time. These changes do not always signal a pregnancy loss.

Anyone who believes that they have lost a pregnancy, with or without bleeding, should seek medical attention.

Pregnancy losses do not always involve bleeding. In fact, a woman may not experience any symptoms and only learn of the loss only when a doctor cannot detect a heartbeat during a routine ultrasound.

Bleeding during pregnancy loss occurs when the uterus empties. In some cases, the fetus dies but the womb does not empty, and a woman will experience no bleeding.

Some doctors refer to this type of pregnancy loss as a missed miscarriage. The loss may go unnoticed for many weeks, and some women do not seek treatment.

According to the American Pregnancy Association, most losses occur within the first 13 weeks of pregnancy. While an estimated 10–25 percent of all recognized pregnancies end in a pregnancy loss, a loss in the second trimester is very rare.

Some women have no external symptoms of pregnancy loss. When the loss occurs early on, a woman may have few signs of pregnancy, which can make identifying the loss more difficult.

It is normal to experience changes in pregnancy signs over time, particularly in the transition from the first to the second trimester. These changes do not usually indicate the loss of the pregnancy.

Some warning signs of a pregnancy loss without bleeding include:

• a sudden decrease in pregnancy signs
• pregnancy tests that show a negative result
• nausea, vomiting, or diarrhea
• back pain

If the pregnancy has advanced, fetal movement may noticeably slow or stop.

Most women seek treatment for a pregnancy loss when they experience bleeding. When there is no bleeding, a doctor may only diagnose a loss during a routine scan.

A doctor may also suspect a loss because of other indications, such as a drop in the levels of pregnancy hormones or an unusual decrease in other pregnancy signs.

Blood tests can determine the levels of hormones, which can help to assess the likelihood of a pregnancy loss. To conclusively diagnose a loss, a doctor must perform an ultrasound to check for a heartbeat.

The heartbeat does not develop until 6.5–7 weeks of gestation, so the absence of a heartbeat before this time does not indicate a loss.

To confirm a pregnancy loss, a doctor may choose to perform scans on multiple days.

To determine the reason for a loss, a doctor may also recommend genetic testing, further ultrasound scans, or blood testing.

The goal of treatment is to remove the fetus and tissue from the uterus and to prevent complications, such as a uterine infection. There is a variety of treatment options available, and a doctor or midwife will be able to advise on the best option.

When pregnancy loss occurs without bleeding, it is often safe to wait for a few weeks before seeking treatment, because the uterus may empty on its own.

When this occurs, a woman can expect bleeding that involves passing the tissue. This usually lasts for less than a week, and cramping may accompany it.

If the uterus does not empty, or if a woman does not want to wait, the most common treatment options are:

• medication that encourages the release of the fetus
• a surgical procedure called dilation and curettage

A doctor may recommend pain medication to reduce associated cramping. Over-the-counter varieties are often effective. If they do not work, a doctor can prescribe something stronger.

In rare cases, pregnancy loss leads to a uterine infection, which requires treatment.

It is essential to consider mental health when choosing a course of treatment. Many women feel immense grief following a pregnancy loss. Guilt and anxiety are also common responses.

Therapy and support groups can help. Some women might also benefit from using antianxiety or antidepressant medications.

Many women worry that they are responsible for the loss of their pregnancies. In most cases, this is untrue, and the loss is outside of a person’s control.

The most common cause of a pregnancy loss is a chromosomal abnormality that would have made it impossible for the baby to survive.

Less common causes include:

• infections
• illnesses
• physical injuries
• abnormalities in the uterus or other reproductive organs
• untreated medical conditions, such as diabetes or kidney failure
• uterine polyps or adhesions
• endometriosis

The recovery time associated with a pregnancy loss depends on many factors, including how far along the pregnancy was.

For most women, the time to physically recover is relatively short. Women who undergo surgical removal of the fetus may experience no physical symptoms after any associated bleeding has stopped.

Those who experience complications, such as a uterine infection, can expect a longer recovery time.

However, the emotional effects of a pregnancy loss can last much longer. Some women grieve for a lifetime. Others feel better after conceiving another baby.

There is no standard timeline, no right way to grieve, and no right way to feel about a pregnancy loss.

Many women find that talking to loved ones, joining a support group, and meeting with a therapist who specializes in pregnancy loss helps.

A 2016 study found that women can safely try to become pregnant again during the cycle that follows a pregnancy loss. In fact, the researchers found that the odds of becoming pregnant may be slightly higher after a loss. Women who are ready to try again should not feel as though they have to wait.

Following a pregnancy loss, many women worry that they will be unable to become pregnant again. However, losses are common and the issues responsible often do not recur.

There is no right way to respond to the loss of a pregnancy. Many people need time to grieve, while others want to try again right away.

Likewise, losses can occur in many ways. Some involve no physical symptoms, while others are painful and require surgery.

Working with trusted healthcare providers can help a woman to deal with the physical and emotional effects of a pregnancy loss.

Miscarriage, symptoms - Health Clinic 365 Yekaterinburg

Causes of miscarriage

Questions to the doctor about miscarriage

Diagnosis of miscarriage

Treatment and prevention of miscarriage

According to statistics, 10 to 20% of all pregnancies end in miscarriage. However, the real numbers could be much higher, as a large number of miscarriages happen very early, and women are not even aware of their pregnancy. Most miscarriages happen due to abnormal development of the fetus. nine0003

Miscarriage is quite common, but this fact does not make things any easier. It is always difficult to cope with the realization that there was a pregnancy, but no child. Try to deal with the situation psychologically and understand what could be causing the miscarriage, what increases the risk of it, and what type of treatment might be needed.