A miscarriage can still happen, even without the typical symptoms of cramping and bleeding. What you need to know about missed miscarriages.

By Bonnie Gibbs Vengrow

A missed miscarriage is also called a silent miscarriage—and for good reason: You won't experience the usual red flags of cramping or bleeding, though some symptoms, like tender breasts or nausea, may start easing up. Instead, you'll find out you've had one once you lie down for an ultrasound and there's no fetal heartbeat. Though the embryo has died, your body hasn't expelled it yet.

The loss can be devastating, but rest assured it's not because of anything you did. A missed miscarriage can happen to anyone. In fact, 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, an issue with the chromosomes is to blame. 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.

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 such 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; 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.

At that point, 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 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.

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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