Symptoms & diagnosis
The main symptoms of miscarriage are vaginal bleeding or spotting, with or without abdominal pain or cramping. But sometimes there are no obvious signs at all.
Bleeding, spotting and/or pain
Bleeding in pregnancy may be light or heavy, dark or bright red, or brown . You may pass clots or “stringy bits”. You may have more of a discharge than bleeding. Or you may have spotting, which you notice on your underwear or when you wipe yourself.
Spotting or bleeding may be continuous or it might be on and off, perhaps over days or even weeks. It doesn’t necessarily mean that you are miscarrying or that you will miscarry [1], but it’s always worth checking.
Pain, like bleeding, can vary. Abdominal pain might be due to a stomach upset or constipation, and backache is common in normal pregnancy, especially as the weeks go by. If you have bleeding or spotting as well as pain, that might be a sign of miscarriage.
If you have continuous low abdominal pain and/or backache in later pregnancy (after 14 or 15 weeks), it’s best to conatct your midwife or maternity department.
If you have acute, sharp abdominal or one-sided pain, pain in your shoulders and/or pain on moving your bowels (having a poo), contact your GP, Early Pregnancy Unit or if necessary, go to A&E (Casualty department). Tell them that you are pregnant and describe your symptoms so they can arrange an emergency scan.
That’s especially important if you have previously had an ectopic pregnancy.
Lack or loss of pregnancy symptoms
Lack or loss of pregnancy symptoms can also sometimes be a sign of miscarriage, but like pain and bleeding, that doesn’t necessarily mean there is a problem. Some women have very little in the way of pregnancy symptoms, and many feel differently in different pregnancies.
But if you have strong pregnancy symptoms which suddenly reduce or stop well before 12 weeks of pregnancy, that might mean that hormone levels are dropping. You may want to do another pregnancy test and/or talk to your GP about perhaps having a scan.
In some cases, there are no signs at all that anything is wrong and miscarriage is diagnosed only during a routine scan. We say more about this here.
Diagnosing miscarriage
Miscarriage is usually diagnosed or confirmed on an ultrasound scan or scans. The person doing the scan needs to be absolutely certain that the baby (or fetus or embryo) has died or not developed, and they may need more than one scan to confirm that – usually with a gap of at least one week.
Having to wait can be very upsetting but it means that there is no risk of damaging an ongoing pregnancy.
In some cases, especially in later (second trimester) pregnancy, there may be no need for the miscarriage to be confirmed by scan. The physical process of bleeding, pain and passing a recognisable pregnancy sac or delivering a baby, is confirmation in itself. Doctors may still advise a scan in some cases just to ensure that the miscarriage is complete.
[1] In Grant A., 1997, A study of the psychological responses of women immediately after spontaneous and threatened miscarriage Leeds University Hospital, St James’s (Unpublished dissertation), it was noted that about half of the women attending an Early Pregnancy Unit because of bleeding in pregnancy had continuing pregnancies.