How can you have a miscarriage and not know it? Learn more about missed miscarriages that happen without cramping, bleeding, or other symptoms of pregnancy loss.

By Bonnie Gibbs Vengrow
Updated December 15, 2019
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A missed miscarriage happens when the embryo has died, but your body hasn't expelled it yet. It’s also called a missed abortion or silent miscarriage—and for good reason: You won't experience the common miscarriage symptoms of cramping or bleeding. Instead, you'll find out you've had a miscarriage once you lie down for an ultrasound and there's no fetal heartbeat. 

Pregnancy loss can be devastating, but rest assured it's not because of anything you did. A miscarriage can happen to anyone. Here’s what you need to know about missed miscarriage symptoms and causes, and what to expect if it happens to you.

Causes of Missed Miscarriage

With a missed miscarriage, your pregnancy started off on the right foot when the fertilized egg implanted in your uterus. But some time in the first trimester, usually around 6 to 10 weeks, the embryo quit developing and the heartbeat stopped.

Though doctors can't always pinpoint a reason for a pregnancy's failure to progress, there are some explanations, says Erika Nichelson, D.O., a board-certified OB-GYN at the Family Childbirth and Children's Center at Mercy Medical Center in Baltimore. Most commonly, there’s a chromosomal issue that makes the fetus incompatible with life. It's also possible that the embryo didn't develop and left behind an empty pregnancy sac (this is called an anembryonic pregnancy) or started to grow but for some reason didn't continue.

Missed Miscarriage Symptoms

In a typical miscarriage, you’ll experience vaginal bleeding, cramping, pinkish-white mucus, and back or abdominal pain. With a silent miscarriage, however, you likely won’t have any side effects. Brownish discharge might be present on some occasions. Some women also experience a loss of their pregnancy symptoms, such as nausea, vomiting, and breast tenderness (although these symptoms also go away naturally as the pregnancy progresses). 

Diagnosing a Missed Miscarriage

The only way for your OB-GYN to diagnose a missed miscarriage is by performing an ultrasound. But even then, most doctors are hesitant to call it based on an absent fetal heart rate in one ultrasound, especially in the very early days. "Dating can be off, especially in women with longer cycles (35 to 45 days), as they would ovulate later," Dr. Nichelson explains. "The pregnancy wheel is based on a 28-day cycle with ovulation on day 14, and that's not always the case."

To gather more information, your OB-GYN will probably send you for an ultrasound that's read by a radiologist. If the radiologist doesn't detect a fetal heart rate, that ultrasound will likely be the last one you'll receive. 

Meanwhile, your doctor will check the quantitative hCG levels in your blood. HCG is a hormone produced by the placenta, and in a viable pregnancy, the number will double every 48 to 72 hours. If it's not increasing enough, and the "official" ultrasound failed to pick up a fetal heart rate, then your doctor will likely declare a missed miscarriage.

What to Do for a Missed Miscarriage

After discovering you have a missed miscarriage, you'll need to discuss next steps, which could include:

  • Letting your body miscarry naturally. "Sometimes, people need to wrap their brain around what just happened and take some time to mourn the loss," Dr. Nichelson says. "You can wait and see if the body will figure out that the pregnancy isn't good. Most of the time—though not always—the bleeding and cramping of the miscarriage will start on its own."
  • Hastening the miscarriage with medicine. If you'd prefer not to wait, your doctor can give you Cytotec (misoprostol), which will help the uterus contract and expel the tissue.
  • Undergoing a dilation and curettage (D&C). If you're further along—think 12 weeks or more—then the fetus may be harder to pass and your doctor may want to perform a D&C, says Dr. Nichelson. This procedure removes the fetal tissue from the uterus. 

Will a Missed Miscarriage Affect Future Pregnancies?

Though trying to conceive may be the furthest thing on your mind after a missed miscarriage, you can try again with your next cycle if you passed the pregnancy on your own or with Cytotec. If you underwent a D&C, you should wait three menstrual cycles before trying again, to give your body time to heal.

And if you do get pregnant again, don't be surprised if you're feeling extra nervous during the first trimester. Dr. Nichelson says patients often have a fear of coming into the office for those early ultrasounds. But there's good news: "Most commonly, a missed miscarriage doesn't happen the second time."

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