Signs of Miscarriage

Chaunie Marie Brusie, RN, BSN and Andrea Dashiell

Miscarriage: It's a topic you never want to think about, let alone discuss, especially if you're pregnant. But it's an all-too-common issue. According to the American College of Obstetricians and Gynecologists (ACOG), about 15 to 20 percent of pregnancies end in miscarriage, though experts expect that there are a significant number of miscarriages among women who don't even know they are pregnant yet. "We estimate that about 30 to 40 percent of all conceptions result in a pregnancy loss," says Helain Landy, M.D., professor and chair of the Department of Obstetrics and Gynecology at Georgetown University Hospital. "This is because many women miscarry before they know they're pregnant, or before it has been confirmed by a health-care provider."

Determining if you're having a miscarriage can be challenging. Many of the signs and symptoms of miscarriage—such as spotting and cramping—also occur during perfectly healthy pregnancies.

But the good news is that women who do have miscarriages usually go on to have successful pregnancies afterward. In fact, at least 85 percent of women who have suffered a miscarriage will go on to have a healthy, full-term pregnancy the second time around.

So if you're experiencing potential signs and symptoms of a miscarriage, don't panic. See what the first signs of miscarriage might be—and learn what you should do if something just doesn't seem right.

Signs and Symptoms of Early Miscarriage

Most miscarriages happen during the first 13 weeks of pregnancy—the first trimester. That's why so many people opt to wait to share their pregnancy news until they make it through the first trimester.

Cramping with spotting is the number one sign of an early miscarriage, according to New York-based Zev Williams, M.D., Ph.D., director of the Program for Early and Recurrent Pregnancy Loss (PEARL) at Montefiore Medical Center/Albert Einstein College of Medicine.

Bleeding. Bleeding during pregnancy is one of the most common miscarriage symptoms, and should always be brought to the attention of a doctor. "We take bleeding very seriously," explains Dr. Joshua Hurwitz, a board-certified OB/GYN and infertility specialist. "That being said, it doesn't mean that every time you bleed, you're having a miscarriage. While a lot of bleeding in pregnancy is benign, we bring a lot of women in for reassurance." You should assess your bleeding before you call the doctor, according to Dr. Hurwitz. "Ask yourself what kind of bleeding it is," he states. "Is it one drop of oldish, brown blood or are you filling up pads with bright red, period-like bleeding? Those are the types of questions we will be asking to help you figure out what's going on." Generally, the heavier the bleeding, the more cause for concern.

Pain can be another sign that something's amiss. The pain may be located in the abdomen, pelvic area, or lower back, and can range from dull and aching to period-like cramping. It may be difficult to distinguish if the pain is normal, since round ligament pain and even cramps can be common during early pregnancy as your body expands for the growing uterus.

Intuition. Other women have no physical symptoms. Dr. Hurwitz describes that many of the calls he receives from patients have simply to do with a patient's feelings about her pregnancy. "She might say, 'I don't feel pregnant anymore,' or "I used to have nausea and now I'm so worried.'" As pregnancy hormones wane after a miscarriage, women might notice decreased breast tenderness or resolving nausea, for instance. But keep in mind that a reduction of pregnancy symptoms is also a completely natural part of pregnancy. Symptoms like morning sickness and breast tenderness tend to decrease as you transition from the first to the second trimester.

Signs and symptoms of later miscarriage

Late miscarriage is one that occurs into the second trimester, about 14 to 20 weeks into the pregnancy. They are far less likely than earlier miscarriages, but they still impact about 2 percent of pregnancies.

Symptoms of miscarriage at 14 weeks or later are similar to the signs of early miscarriage—but the pain and bleeding will be more pronounced, and you may pass significant clots with the bleeding.

Another potential later miscarriage symptom is decreased activity of your baby. Pay attention to her activity levels, and if you notice a sudden or drastic decrease in her activity, be sure to let your doctor know so he can determine if further testing is necessary.

What to do if you're experiencing miscarriage symptoms

Whether you're early in your pregnancy or farther along, if you experience any symptoms that are troubling, give your doctor a call. "It's far better to call and be told that there is nothing to worry about than not to call and miss something important," asserts Dr. Williams. "Bleeding or pains early on in a pregnancy are both good reasons to call and get checked out."