Cramping during pregnancy is one of the top symptoms that give most moms-to-be pause—especially in the first trimester, when the risk of miscarriage is at its highest. A miscarriage can happen any time up to 20 weeks, but the vast majority occur before 13 weeks. Between weeks 13 and 19, the chances of miscarriage drop to 1 to 5 percent.
Though the discomfort could be a sign of a larger issue, not every ache and pain means your baby is in distress. In fact, some discomfort and cramping is to be expected during pregnancy, as your body adjusts to and nurtures your growing baby. Each trimester provides plenty of opportunities to feel the pain, though—from implantation cramps to round ligament pain to contractions that signal it's go time.
So when does cramping during pregnancy mean miscarriage? It depends on how much pain you're feeling, what other symptoms you have, and how far along you are in your pregnancy, says Siobhan Dolan, M.D., a medical advisor to the March of Dimes and an attending physician in the Division of Reproductive Genetics at Montefiore Medical Center, the University Hospital for Einstein, in New York City. "Miscarriage is more common earlier in pregnancy, and this is often due to genetic changes in the pregnancy," she explains. "The further along you get in pregnancy, the less likely you are to have a miscarriage."
That said, if you're experiencing serious, constant cramping and spotting or heavy bleeding during pregnancy, call your ob-gyn right away, because those could be signs of a miscarriage, Dr. Dolan says. A call to your doctor is also in order if you're having severe pain, especially if it's on one side of your pelvis, that's sustained or getting worse. That could be a sign of an ectopic pregnancy, in which the egg implants someplace other than the uterus, most often in the fallopian tube. In the unlikely event that you have an ectopic pregnancy, you may experience intense pain and bleeding between your 6th and 10th weeks of pregnancy, as the tube becomes distended.
Otherwise, be mindful of the degree of pain you're feeling. "If cramping is mild, take it easy. No tampons, no douching, no intercourse. Let the pregnancy play out its course," Dr. Dolan says. "If it's serious cramping, sustained pain, or pain that's getting worse, and if it's accompanied by vaginal bleeding, talk to your doctor."
When to pregnancy cramps warrant a call to your doctor
Don't hesitate to call your doctor if you feel like something's not quite right. "I would rather a patient call with any concerns because I wouldn't want her not to call and later find that it was something significant," Dr. Greenspan says. Call immediately if you have any of these signs:
- Pelvic pain that you can't walk or talk through
- Any bleeding
- Fever and/or chills
- Severe headache
- Sudden swelling of the face, hands, and/or feet
- Persistent nausea and/or vomiting
- Less than 10 fetal kicks in one hour, from 28 weeks until delivery
- More than four contractions in an hour for two hours
- Watery, greenish, or bloody discharge