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Signs and Symptoms of Miscarriage

When you see a miscarriage portrayed on television or a film, you often see a woman suddenly overcome with excruciating pain and then collapsing in a pool of blood. In fact, that’s not what happens to most women. Pregnancy Loss can often happen when there are no obvious symptoms 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 in pregnancy doesn’t always mean that there is a problem, however like bleeding, pain 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.

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 pregnancy loss 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.

My GP won’t refer me for a scan…

If your GP won’t refer you for a scan, it might be because it is too early to be able to see even a healthy pregnancy on scan (see our section on ultrasound scans).   But it might be that they take a “wait and see” approach and advises you to stay home and put your feet up, or to stay in bed – or just to go about your normal routine.

You might find this very frustrating and even frightening, especially if you are feeling very anxious:

• If it’s your first pregnancy, you may worry because you don’t know what is normal and what isn’t.
• If you have had a previous healthy pregnancy, you may worry because this pregnancy is not progressing in the same way.
• And if you have previously lost a baby, you are likely to be particularly anxious because of what happened last time.

But I really want a scan…

If you want a scan because of bleeding or spotting, and you can’t get an appointment at an Early Pregnancy or Emergency Gynaecology Unit, you could go to your nearest Accident & Emergency Department.  Bear in mind that you might have a long wait and that they may not be able to scan you there and then.

If you want a scan for reassurance, you might decide to go for a private scan (try putting “early pregnancy scan” and the name of the nearest town into your search engine).  Clinic standards do vary so it is best to check on each clinic’s website:

• if their sonographers (scan operators) are qualified radiographers, or midwives or nurses who are trained in ultrasound scanning
• if they offer diagnostic scans (ones that check for a hearbeat and other signs of a normally developing pregnancy)
• if they state that they refer women to NHS services if there or any concerns or uncertainties
• if they are registered with the Care Quality Commission (CQC) if in England, the Care Inspectorate in Scotland and Wales or the Regulation and Quality Improvement Authority (RQIA) in Northern Ireland. 

What should I do if I think I’m having a miscarriage?

Whatever you do – have a scan, stay in bed or continue your usual routine – it’s very unlikely to make a difference to the outcome of your pregnancy.  Sadly, if the bleeding is because the pregnancy is miscarrying, it is very unlikely indeed that anything can be done to stop this. (The only exception might be if the bleeding occurs in the last few months of the pregnancy).

Resting in bed might slow down any bleeding, but when you get up, perhaps to go to the toilet, it’s likely to start again.  That’s not your fault – it’s just because of gravity. (Again, the only exception might be in the later months of pregnancy.)

Some people prefer to rest, others to continue their usual routine. It makes sense to do what feels right for you.

If you are not sure, or something doesn’t feel right for you, speak to your doctor or get in touch with us to talk things through.

[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.