Some miscarriages occur suddenly without warning; however, many are preceded by a few recognizable early symptoms and signs. Learn some of the potential health issues to watch out for in the early weeks.
Very Early Miscarriage
To grasp how a miscarriage, or early pregnancy loss, happens, it can help to look at how pregnancy occurs. Ovulation prompts the ovary to release an egg, which travels slowly down the fallopian tube toward the uterus. While the egg is in the fallopian tube or after it reaches the uterus, it can be fertilized by sperm. That's when it begins to divide.
By the time the fertilized egg is five days old, it has divided into a large ball of cells called a blastocyst. Around the tenth day, the blastocyst embeds itself into the lining of the uterus, which completes conception. Next is implantation, when the blastocyst breaks down tissues for nutrients. If the tissue provides inadequate nutrients, a miscarriage occurs.
Many people don't notice a very early miscarriage. Common symptoms include a very heavy period flow. If a person isn't aware they were pregnant, they may assume that it was just a late, heavy period.
Chemical pregnancies never reach a stage of viability and are often lost soon after fertilization or implantation. With a chemical pregnancy loss, you might have early spotting, but most women are unaware of this type of pregnancy or its loss. Consider the possibility if you have heavier vaginal bleeding than normal at the time of your expected next period or a few days later. Women may experience this type of miscarriage before a missed period.
Most miscarriages occur during the first 13 weeks of pregnancy, according to the American College of Obstetricians and Gynecologists (ACOG), though they can happen up to 20 weeks.
Symptoms & Signs of an Early Miscarriage
Though the earliest miscarriages may not be detected, there are some things to watch for once you've confirmed you're pregnant. The Mayo Clinic outlines three crucial signs of early miscarriage to watch out for.
- Vaginal Bleeding
- Lower Abdominal/Pelvic Pain
- Passage of Tissue, Fluid, or Mucus
Vaginal bleeding is the major early symptom of a miscarriage, occurring in 15 to 25% of pregnancies in the first trimester, according to ACOG. The bleeding can be constant or intermittent, and the amount might depend on the weeks of your pregnancy.
Bleeding, however, does not always mean a miscarriage is inevitable. About half of those who experience bleeding progress to normal, full-term delivery. Still, blood can be alarming. Call your doctor or midwife if you notice any type of bleeding, especially if you have the following:
- Dark brown or pink staining, or spotting of bright red blood on underwear
- Small to moderate amounts of dark or bright red blood, with or without clots or tissue-like material
- Heavy bleeding that soaks through more than one sanitary pad an hour
- Bleeding that starts suddenly and comes in gushes
- Increasing amounts of bleeding
- Lower abdominal pain
- Passing tissue or fluid through the vagina
Brief vaginal bleeding can occur early at the time of implantation. Later in pregnancy, any bleeding might indicate an inflammation or infection of the cervix, not necessarily a miscarriage.
Lower Abdominal/Pelvic Pain
As your uterus adapts to your pregnancy, some mild lower abdominal and pelvic cramping with vaginal spotting can occur at implantation and during the first trimester. However, persistent intermittent or continuous cramps or pain can be an early symptom of a miscarriage.
Pelvic cramps or pain may accompany vaginal bleeding and might be due to opening of the cervix and/or uterine contractions. The intensity of pain varies but consider the strong possibility of an inevitable miscarriage if you have:
- Moderate to severe pelvic cramping or pain that is worse than your typical menstrual cramps
- Accompanying lower back pain
- Persistent pain throughout the day
- Vaginal bleeding with the pain
Call your doctor for persistent, strong, or worsening symptoms, whether or not it is accompanied by vaginal bleeding.
Passage of Tissue, Fluid, or Mucus
If there is a threat of a miscarriage, in addition to vaginal bleeding you may notice the following:
- Passage of bloody or white-pink mucus material that looks like tissue; it might be hard for you to decide if this represents parts of the pregnancy (fetal or placental tissue) from small blood clots.
- A sudden gush or slow leaking of fluid from your vagina, especially during the second trimester, might be cause for concern.
Doctors advise you to put any tissue-like material in a clean container to preserve it for medical examination. Seek prompt medical attention if you note the passage of tissue or fluid from your vagina.
Other Symptoms & Signs
In addition to the three most common alerts of a miscarriage, you might notice changes in these pregnancy-related symptoms and signs.
- Diminishing morning sickness: Abrupt or gradual disappearance of morning sickness might mean the pregnancy stopped developing and will miscarry, although it is normal for this symptom to decrease as your pregnancy advances.
- Decreasing breast tenderness: An early sign of pregnancy, breast tenderness might decrease or disappear early with an impending miscarriage.
- Lack of a fetal heartbeat: Not finding a fetal heartbeat on early ultrasound at six weeks of pregnancy or after, or loss of a previously established heartbeat, signifies a non-viable fetus that might miscarry before medical intervention.
- Unexplained weight loss: Increasing weight gain after the second trimester is normal, but weight loss during this time might signal a non-viable pregnancy which is soon to miscarry.
Seek Medical Attention
Chemical pregnancies (before an ultrasound can detect a fetus) and other early miscarriages before six weeks often don't require medical treatment. However, even if your pregnancy is early, see your doctor or seek prompt medical care if you have moderate to severe vaginal bleeding or pain — or any concern.
Bear in mind spotting or irregular vaginal bleeding, or one-sided pelvic or lower abdominal pain can be a sign of an ectopic pregnancy. This can rupture and cause an emergency at any moment, so consulting a doctor is paramount.
Causes of an Early Miscarriage
Many times the cause of a miscarriage is unknown. Experts believe that babies who would be born with serious physical or developmental disabilities are often miscarried. Sometimes an egg just doesn't develop correctly.
It's normal to feel you could have done something different to prevent a miscarriage, but in most instances, nothing would change the outcome. Rarely are miscarriages directly related to certain actions.
Depending on your history, your doctor might suggest an evaluation to gain insight about your pregnancy loss and the chance of a recurrence. The extent of your evaluation will depend on your weeks of pregnancy and how many times you have miscarried.
Seeking Support Can Help
There are two crucial support systems to lean on — your OBGYN and therapists. Your doctor will help with any needed medical assistance, and a therapist can help you emotionally.
Sadly, miscarriages are a common reality of pregnancy, but that doesn't make the reality of this loss any easier. Be gentle with yourself. This experience may bring up a wide range of emotions. If you can't see a therapist, seek support from a trusted friend to help you through these feelings.
Many communities have support groups in person, and also online. It's devastating to lose a pregnancy, and working through your emotions with experts and others who experienced the same may help you best get through.
While it's a difficult subject, learning some of the key facts about miscarriage can help identify when to seek medical advice. Stay healthy and know when to reach out to your care team on your journey.