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Missed miscarriage

The shock of a missed miscarriage can be very difficult to deal with – as is any baby loss. Understanding the facts of exactly what a missed miscarriage is and how it will affect your body will help you cope with this difficult time.

 

What is a missed miscarriage?

A missed miscarriage, sometimes called delayed marriage, is when your baby has died in the womb but you haven’t passed the pregnancy tissue yet. This might mean you haven’t bled or experienced any pain usually associated with losing your baby, or you may have experienced only very mild symptoms.  It can also be called a silent miscarriage (usually when there have been no symptoms at all).

As in these circumstances, women do not experience the classic miscarriage signs, it can go unnoticed. This means that missed miscarriages are often discovered during routine antenatal scans, such as your 11-14 week dating scan.

Your doctor or sonographer may see there is no heartbeat or that your baby is too small for the date of your pregnancy. Sometimes they will need to confirm the diagnosis by bringing you back for a further scan a week later.

 

Are there any symptoms of a missed miscarriage?

Often women do not experience any symptoms at all – or may experience some mild bleeding or cramping. Some women experience a sudden loss of pregnancy symptoms – such as morning sickness and breast tenderness. But this doesn’t always happen.

Even if you have had a silent miscarriage, your body still thinks you’re pregnant. Whilst the baby may have died, your placenta may still be producing hormones that cause pregnancy symptoms.

However, it’s important to remember that a loss of pregnancy symptoms can also happen during a healthy pregnancy. After the first trimester, symptoms like sickness and fatigue tend to resolve, so a loss of these symptoms is usually no cause for concern.

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So, can you have a miscarriage and not bleed?

You can be diagnosed with a miscarriage without having had any bleeding. However, for the pregnancy tissue to pass, and the lining of the womb to shed, you will need to have some bleeding at some point (or a surgical procedure to remove the pregnancy tissue).

It’s also important to understand that many pregnant women will experience light spotting at some point during their pregnancy. This is quite common and usually will not affect the health of your growing baby. However, if you are experiencing spotting you should always check in with your GP.

 

When can a missed miscarriage occur?

A missed miscarriage can occur at any point during your pregnancy. However, it is much more likely to happen in the first few weeks of being pregnant. Many silent miscarriages are discovered at the first-trimester scan, between 11 and 14 weeks.

 

When is the highest risk for silent miscarriage?

As with any miscarriage, the risk is always higher in the first trimester. Miscarriages can occur later in the pregnancy but that is far less common.

 

How common are missed miscarriages after seeing a heartbeat?

After a scan at 8 weeks showing a healthy foetal heartbeat, your chances of miscarriage, silent or otherwise, drops to 2%. However, most people don’t have a scan until the standard NHS time of 11-14 weeks. The risk of miscarriage continues to reduce as your pregnancy goes on.

 

Can you have a miscarriage without a positive pregnancy test?

For some women, who have a very early miscarriage, they may assume that the bleeding and cramps are just a normal period. In these cases, they may not have done a pregnancy test at all, or the pregnancy may have been so early that a test hadn’t picked it up. However, most modern tests are able to pick up very low levels of HCG, so people are finding out they are pregnant earlier than before.

 

How long can a missed miscarriage last?

Sometimes, it can take some time to make a diagnosis. Early pregnancy units will always err on the side of caution. If at a scan, your pregnancy looks smaller or much less advanced than would be expected by the timing of your last period, or the time at which your pregnancy test was first positive, it will raise a concern about the possibility of a miscarriage.

However – it is obviously extremely important not to get this diagnosis wrong, and diagnose a miscarriage incorrectly – so in many cases, when things are not absolutely certain, they will ask you to come back for another scan in one or two weeks (depending on what they saw). They will call this a pregnancy of uncertain viability. At this point, you may have miscarried naturally. If not, the doctor will confirm the missed miscarriage and offer you support and advice on next steps.

If you have a missed miscarriage diagnosed, and choose expectant management – where you wait for the pregnancy tissue to pass – then a miscarriage can take many weeks to start. Usually, the worst part of a miscarriage is over in a day or two, once it starts – but bleeding can continue for two weeks (or longer if some tissue is left behind).

 

What will happen if I have had a silent miscarriage?

If you have a silent miscarriage confirmed, your doctor will offer you a few different options.

One option is to wait for this miscarriage to happen naturally (often called expectant or conservative management). However, some women find it difficult not knowing when the bleeding will start.

Another option may be to take tablets to start the process of a miscarriage (usually misoprostol, which are given as small tablets which can be placed inside the vagina). This is called medical management.

A final option is to have surgical management of miscarriage. Historically this has been called an ERPC (Evacuation of Retained Products of conception), or your parents generation may call it a ‘D&C’ (dilatation and curettage – but note, we don’t use curettage these days). For this, the neck of the womb (cervix) is gently opened, and a small suction tubing placed inside the womb to remove the tissue. It is a very quick procedure and is usually done while you are asleep (under general anaesthetic).

Some hospitals are able to offer this with you awake – in which case it is usually referred to as an MVA (or Manual Vacuum Aspiration).

The choice of management is very personal – and you should discuss the pros and cons of each with your doctor. None of the choices has been shown to have any differences in terms of your future ability to have children. Expectant and Medical management is less ‘predictable’ – so you are more likely to need to be admitted to hospital with heavy bleeding, for example.

It’s for this reason that many people choose surgical management. Your doctor may also guide you towards surgical management if you are further along in the pregnancy (more than 10 weeks), or at risk of heavy bleeding from medical or expectant management.

 

Can I get pregnant again after a missed miscarriage?

Yes. Whilst emotionally, this will obviously be an incredibly trying time, remain positive – you should be able to get pregnant again. If you have miscarried naturally, with medication or surgery you will be able to try again after your first cycle, if of course, you feel emotionally and physically ready to do so. There is no increased risk of miscarriage from starting trying quickly.

 

How can I avoid miscarriage?

Miscarriage is, unfortunately, almost impossible to predict or avoid.

The vast majority of miscarriages are down to genetic problems. This means that the complex chemical reactions that occur during conception are not quite as they should be. Sadly miscarriages happen because the body knows that the baby would not be able to develop healthily and survive to the end of the pregnancy. This is why the majority of miscarriages aren’t preventable.

In a few cases, there may be some physical issues that could put you at risk of recurrent miscarriage. These will usually be identified as recurring miscarriage (3 or more miscarriages). There is also recent research to indicate that sperm health could be linked to recurrent miscarriage. All too often, the focus is on a woman’s body, but both partners should be tested if miscarriage is happening each time you fall pregnant.

The most important thing to remember is that miscarriage is not your fault. It is usually completely random and you should be able to have a healthy pregnancy after a miscarriage.

 

What should I eat to avoid miscarriage?

Your diet will not help you prevent a miscarriage, and there is no magical food that will help you avoid it. However, a healthy, balanced diet will increase your chances of a healthy pregnancy. Your baby needs nutrients to grow and develop, and it gets all its sustenance from your diet. If you are trying to get pregnant, having a fertility diet plan can be useful for keeping you on track.

Whilst there’s no food that will directly prevent miscarriage, there are unhealthy habits you should avoid to reduce your risk. Smoking, drinking alcohol and taking drugs whilst pregnant can make miscarriage more likely.

 

Can folic acid prevent miscarriage?

Whilst taking folic acid will not directly prevent miscarriage, it will help you have a healthy pregnancy. Taking folic acid will help prevent certain defects that can occur in the very early stages of pregnancy. Specifically, folic acid has been linked to reducing cases of Neural Tube Defects. These occur in the first few weeks of pregnancy and include spina bifida and anencephaly.

You can read more about the impact of folic acid and how you can incorporate it into your preconception care in our folic acid blog.

There is also evidence to support that Vitamin D deficiency could be linked to miscarriage amongst women with previous pregnancy loss. Whilst you can help increase your vitamin D levels by getting lots of natural sunlight and eating a vitamin D rich diet, it may also be advisable to take a vitamin D supplement as part of your preconception care plan. You can read more about the benefits of Vitamin D in our Vitamins for Fertility blog post.

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Can stress cause a missed miscarriage?

There is no proven link between miscarriage and stress. This is a fertility myth that unfortunately many women believe – putting unnecessary blame on themselves at what is already a difficult time. Fertility struggles of any kind are understandably going to cause stress. For your own sake, learning how to manage your emotions healthily will help you have resilience on your fertility journey.

Common symptoms of stress include lack of sleep, unhealthy habits, and bad diet. Whilst these symptoms won’t directly cause miscarriage or fertility struggles, a healthy lifestyle will improve your chances of a healthy pregnancy.

 

How can I cope with a miscarriage?

Experiencing a miscarriage at any point in your pregnancy can be understandably devastating and impact your mental health. Even if you were in the early stages, it’s likely you will have been planning for the future and already very much in love with your baby. You have every right to deal with your grief in any way you like, and you should surround yourself with people who are understanding and supportive of you.

Whilst it can be tempting to retreat into yourself during this tough time, talking to other people will help. Whilst there is no proven link between fertility and stress, looking after your mental wellbeing when you’re on a fertility journey and getting the support you need is important. Don’t be afraid to ask for help when you need it.

Remember, miscarriage is more common than we think, so you may have friends or family members who have experienced the same thing. There are many charities out there that can offer support to couples and families going through a miscarriage. Tommy’s is a great source of guidance and support and we also love the incredible work Saying Goodbye does.

There are also lots of books that deal with coping with infertility and loss, we’ve recommended some of our favourite fertility books here.  It’s important to remember that this is not your fault and you are not alone.

Reviewed by our experts.

 

Adia digital meet up

We recently held a digital meet up where we spoke to Dr Jessica Farren all about miscarriage. If you weren’t able to make the meetup but would like to listen to the conversation, you can find the audio recording here.

 

If you are searching for support on your fertility journey or have experienced a miscarriage you can talk to our experts for free on the Adia platform. You can ask questions, find support groups and advice on how to cope with infertility.

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