Signs of Miscarriage: When Should I Worry?

How do you know if you’re having a miscarriage? Learn about miscarriage symptoms and what to do if something doesn't seem right.

Miscarriage is the spontaneous loss of a pregnancy in the first 20 weeks. According to the American College of Obstetricians and Gynecologists (ACOG), about 10% of known pregnancies end in miscarriage, and 80% of miscarriages occur in the first trimester. However, experts believe the true miscarriage rates are actually higher.

"We estimate that about 30 to 40% of all conceptions result in a pregnancy loss," says Helain Landy, MD, professor and chair of the Department of Obstetrics and Gynecology at Georgetown University Hospital. She says that is because many miscarry before they know they're pregnant or before a health care provider has confirmed the pregnancy.

Despite how common miscarriage is, pregnancy loss has historically been a taboo subject, which means that many pregnant people don't have the facts about what miscarriage can look like. Read on to learn about the signs and symptoms of miscarriage and what to do if you think you may be miscarrying.

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The Most Common Signs of Miscarriage

Zev Williams, MD, PhD, director of Columbia University Fertility Center, explains that there is no "one way" that someone will experience a miscarriage, and there can be a wide range of symptoms.

"For example, you can have a patient with all the typical symptoms of a normal pregnancy, such as morning sickness, and no alarming symptoms at all, but have a pregnancy loss," he says. "Alternatively, we have had patients with significant bleeding and cramping but go on to have a healthy full-term delivery."

Jennifer Jolley, MD, professor of obstetrics and gynecology at the University of California, Irvine, agrees: "Depending on the medical situation, the physical process of losing a pregnancy can vary from person to person," she says.

Dr. Williams adds that one of the most common types of miscarriage he sees at his fertility practice is a missed miscarriage, which is when fetal cardiac activity stops, but the patient is not yet experiencing any other signs of losing the pregnancy. While not all miscarriages have noticeable symptoms before they are diagnosed, there are a few common signs of miscarriage to know.

Uterine cramps

Cramping with spotting is the number one sign of an early miscarriage, according to Dr. Williams. Miscarriage cramps occur because uterine contractions are what expel the contents of the uterus. According to ACOG, miscarriage cramping is generally more intense than the cramping you experience with your period. The cramping usually stops within a day.

Vaginal bleeding

Vaginal bleeding is another common sign of miscarriage, and it should always be brought to the attention of a health care provider. "We take bleeding very seriously," explains Joshua Hurwitz, MD, a board-certified OB-GYN and infertility specialist in Danbury, Connecticut.

Not all bleeding during pregnancy means miscarriage, but prenatal care providers often have people who are bleeding or spotting come in for reassurance that everything is fine, he adds. Generally, the heavier the bleeding, the more cause for concern. Similarly, some people will pass discharge (white-pink mucus), tissue, or clot-like material while having a miscarriage.

According to ACOG, like with cramping, miscarriage bleeding is heavier than you would experience with your period. With a miscarriage, most of the tissue will pass within two to four hours, but spotting can last as long as six weeks.

Pain

Pain can be another sign of miscarriage. This pain may be located in the abdomen, pelvic area, or lower back, and it can range from dull and aching to period-like cramping. It may be difficult to distinguish miscarriage pain from normal pregnancy aches and pains, however, since abdominal cramping and round ligament pain are common as your body expands for the growing uterus.

Decreased fetal movement

With late miscarriages that occur in the second trimester (about 14 to 20 weeks into pregnancy), decreased fetal movement can also be a sign of miscarriage. This can be a tricky miscarriage sign to recognize since fetal movement is much more difficult to detect consistently early on in pregnancy. In fact, most pregnant people won't experience the first fetal kicks (known as "quickening") until 16 weeks or later, and health care providers generally don't recommend pregnant people start official fetal kick counts until the third trimester.

I Have Miscarriage Symptoms—Now What?

The most common symptoms of a miscarriage are bleeding or cramping, but not all cases of vaginal bleeding or abdominal cramping mean miscarriage, especially in the first trimester. And not all miscarriages will begin with bleeding or cramping.

That said, J. Daniel Woodall, DO, MPH, FACOG, an obstetrician and gynecologist at Spectrum Health Pennock in Hastings, Michigan, says that the first thing you should do if you think you might be having a miscarriage is to notify a prenatal care provider.

"It's far better to call and be told that there's nothing to worry about than not to call and miss something important," says Dr. Williams. "Bleeding or pain early on in a pregnancy are both good reasons to call and get checked out."

Some people experience bleeding during pregnancy as a symptom that's within the range of "normal," so it can be difficult to tell if the bleeding is related to a miscarriage or something else, says Dr. Woodall. A prenatal health care provider can help you determine your next steps, such as scheduling an appointment in-office for an ultrasound, setting up a blood test to measure your hCG levels, or going to the emergency department.

And you shouldn't hesitate to reach out for help even after hours. "All OB practices should have emergency provider numbers where patients can call 24 hours a day to speak to a provider on call," Dr. Woodall notes.

What the Doctor Will Want to Know

When you do call a doctor, midwife, or other health care provider about possible miscarriage symptoms, they will ask you a series of questions about your symptoms to help determine what is going on and what to do next, so it's helpful to be prepared to give them the information they need.

According to Dr. Woodall and Dr. Williams, a health care provider will want to know the answers to the questions like the following:

  • Are you bleeding? If so, what color is it, and is the bleeding light or heavy?
  • Are you in pain?
  • Are you feeling lightheaded or dizzy?
  • Are you short of breath?
  • Do you have a fever or foul-smelling vaginal discharge?
  • When was the first day of your last period?
  • What is your blood type?
  • Have you had a miscarriage before?

The primary symptom the medical provider will look for, says Dr. Woodall, is bleeding. They'll also likely want to know how long you've been bleeding and how much you're bleeding as too much blood loss may warrant a trip to the emergency department.

"As a general rule, if a [person] is bleeding through a pad per hour for more than two to four hours in a row or has a fever, I always recommend emergency evaluation," he says. Gaiski also points out that it's very important to head to the emergency department if you are feeling lightheaded, dizzy, or are near passing out and don't have a lot of bleeding because those can be signs of an ectopic pregnancy, which is life-threatening if it ruptures.

What If You're Just 'Not Feeling Pregnant' Anymore?

At the beginning of pregnancy, before you can feel your baby kick, you don't really have a way to know how your baby is doing at home. (Experts don't recommend using at-home dopplers to monitor your baby's heartbeat.)

Without a way to tell how your baby is doing in those first few months between prenatal visits, you may use the presence of pregnancy symptoms to reassure yourself that everything is going just fine in there. But what about if you experience a sudden drop in symptoms? What if you wake up and the morning sickness is gone and your boobs don't feel as sore? If that happens, don't panic.

Dr. Hurwitz says that many calls he receives from patients have to do with how they are feeling. Some people say they don't feel pregnant anymore or are worried when their nausea subsides.

While it is true that pregnancy hormones—and by extension, pregnancy symptoms—wane after a miscarriage, the loss of symptoms is rarely the first sign of miscarriage. Plus, symptoms like morning sickness and breast tenderness tend to decrease as you transition from the first to the second trimester.

Pregnancy symptoms can fluctuate, and every pregnant person will experience them differently. "The loss of pregnancy symptoms is not predictive of miscarriage," explains Dr. Woodall. Of course, always talk with a pregnancy care provider about any symptoms (or lack thereof) that concern you.

What Happens Next

Ultimately, the only true way to tell if you have had a miscarriage is through an ultrasound to examine the uterus and blood work to evaluate your hCG levels. "Rapidly dropping hCG levels generally indicates a complete miscarriage, as would an empty uterus," explains R. Renee Gaiski MSN, CNM, a certified nurse midwife with Spectrum Health Pennock in Hastings, Michigan.

The most common cause of first-trimester miscarriage is thought to be chromosomal abnormalities in the embryo or fetus that stop it from developing as expected. In most cases of early miscarriage, however, the cause remains unknown, which can be difficult to grapple with when you want answers.

In the case of miscarriage that occurs later in pregnancy or with recurrent miscarriage (that is, two or more consecutive miscarriages), a health care provider may recommend additional evaluation and testing to try to determine the cause.

Whether you choose to try to conceive again or not, it's incredibly important that you allow yourself space and time to heal and grieve in a way you need. "Whether it was six weeks, 12 weeks, or more, it's a loss that you will never forget, and that is OK," says Gaiski. "Even if the pregnancy wasn't necessarily 'planned' or even 'wanted,' it is very normal to have intense sadness."

She recommends seeking professional treatment, counseling, and talking through your experience—because no matter how isolating the experience can feel, you are never alone when it comes to miscarriage.

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Sources
Parents uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Early pregnancy loss. American College of Obstetricians and Gynecologists. 2018.

  2. What happens after a miscarriage? An OB-GYN discusses the options. American College of Obstetricians and Gynecologists. 2022.

  3. Ultrasound Exams: Frequently Asked Questions. American College of Obstetricians and Gynecologists. 2021.

  4. Miscarriage. StatPearls. 2022.

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