Miscarriage Bleeding: What Does It Look Like?
Defined as the spontaneous loss of a baby in the first 20 weeks of pregnancy, miscarriage is a surprisingly common phenomemon. In fact, about 15 to 20 percent of known pregnancies end in miscarriage, according to the American College of Obstetricians and Gynecologists (ACOG). That might explain why pregnant women obsess about every new pain or symptom—especially the ominous uterine cramping and bleeding.
But what does miscarriage blood look like, and can you have a miscarriage without bleeding? We spoke with experts to answer your most pressing questions.
- RELATED: What Causes Miscarriage to Happen?
Am I Having Miscarriage Bleeding?
Uterine cramping and bleeding are the most common miscarriage symptoms, says Dr. Joshua Hurwitz, a board-certified OBGYN and infertility specialist. They’re caused by contractions that expel the contents of the uterus. A miscarrying woman may also pass large blood clots and fetal tissue.
Although bleeding during pregnancy is always cause for concern, it doesn’t necessarily indicate a miscarriage. In fact, about 20 to 30% of women bleed a little in early pregnancy, and only half of those go on to miscarry, says Jeanne Faulkner, R.N., author of Common Sense Pregnancy: Navigating a Healthy Pregnancy and Birth for Mother and Baby. Other causes of bleeding in pregnancy might include hormonal changes, cervical irritation, and implantation (when the egg implants into the uterine lining).
What Does Miscarriage Blood Look Like?
It can be difficult to discern the difference between a miscarriage or period. In fact, if you don’t realize you’re pregnant, you might believe that miscarriage bleeding is part of your monthly menstrual cycle.
But here are a few indicators: Miscarriage bleeding may start as light spotting and increase in intensity as the uterus empties. It might also start suddenly and heavily, especially if you lose the baby in the second trimester; that’s because the fetus is bigger so you’ll have more miscarriage tissue to expel. (Spontaneous pregnancy loss in the second trimester is far less common, and it only happens in 2% of pregnancies) A miscarriage with multiples also comes with greater amounts of blood than singleton pregnancies.
In terms of color, miscarriage bleeding can range from red to brown to pink. Miscarriage blood clots are likely larger than ones you pass during your monthly period, and they might also contain fetal tissue.
How Long Do You Bleed After a Miscarriage?
The amount and duration of miscarriage blood depends on your pregnancy. However, you can expect the heaviest bleeding for several hours after the miscarriage begins, as your body expels most of the miscarriage tissue. You might also have lighter bleeding after the miscarriage for an additional one or two weeks.
Can You Have a Miscarriage Without Bleeding?
Miscarriage symptoms vary for everyone and bleeding isn’t always present, says Jennifer Jolley, M.D., Assistant Professor of Maternal-Fetal Medicine at the University of Washington in Seattle. Some women don’t experience any symptoms of miscarriage at all. This is often called a “missed miscarriage,” and it’s only detected through fetal ultrasound.
Other women have some combination of cramping, bleeding, uterine pain, white-pink mucus, miscarriage clots, and loss of pregnancy symptoms. Always visit your doctor for any unusual or worrisome changes in your pregnancy.
I Might Have Miscarriage Bleeding—Now What?
Dr. Hurwitz advises anyone who’s bleeding during pregnancy to visit their OBGYN. Be prepared to answer a few questions. For example: What color is the blood? When did the bleeding start? How much am I bleeding? Use a panty liner or pad (never a tampon) to keep track.
Your doctor or midwife will run blood tests and conduct ultrasounds to determine if you’re having "normal" bleeding or miscarriage bleeding. If they detect a miscarriage, the process is usually completed by the body without complications. In the case of a missed miscarriage, a drug can be given to stimulate these contractions.
But "if there is concern the woman could continue to bleed heavily without effective passage of the tissue, the recommendation is usually to proceed with quick evacuation of the uterus—a dilation and curettage,” says Dr. Jolley. "Otherwise, it can become dangerous for the woman."
Dilation and curettage, or D&C as it's commonly called, is a surgical procedure to complete the miscarriage. Dilation will open the cervix, if’t is still closed, and curettage removes the contents of the uterus using a variety of suction and scraping instruments.
The Bottom Line
Although the presence of spotting does not always indicate a miscarriage, it’s a sign that something abnormal may be going on in the pregnancy. "Even if everything looks normal, the fact that the patient's had spotting will be kept in the back of our minds throughout her pregnancy, says Helain Landy, M.D., professor and chair of the Department of Obstetrics and Gynecology at Georgetown University Hospital.
And if you do have a miscarriage, don’t beat yourself up about it. The majority of miscarriages are random events that can’t be prevented or predicted. Indeed, 70 percent of miscarriages in the first trimester, and 20 percent in the second trimester, result from chromosomal abnormalities that make the fetus incompatible with life. Miscarriages also don’t affect your future fertility, and your subsequent pregnancies have a very good chance of progressing without a hitch.