Some miscarriages occur suddenly without warning; however, many are preceded by a few recognizable early symptoms and signs. Though a miscarriage is defined as a pregnancy loss up to 20 weeks, most occur during the first 13 weeks of pregnancy, according to the American College of Obstetricians and Gynecologists (ACOG). It is therefore useful to know what to watch out for in the early weeks of your pregnancy.
The Very Earliest Miscarriage
When a woman ovulates, her ovary releases an egg, which travels slowly down the fallopian tube toward the uterus. While the egg is in the fallopian tube or after it reaches the uterus, it can be fertilized by sperm. After it is fertilized, it begins to divide. By the time the fertilized egg is five days old, it has divided into a blastocyst, which is basically a large ball of cells. Around the 10th day, the blastocyst embeds itself into the lining of the uterus, which completes conception, making you technically pregnant.
The next event that occurs is implantation during which the blastocyst breaks down tissues for nutrients. If the tissue provides inadequate nutrients, a miscarriage occurs. The symptoms of this type of a very early miscarriage may seem more like a very heavy period. Instead of recognizing very early miscarriage, many women assume they just had a late, heavy period.
Early Symptoms and Signs of an Early Miscarriage
While most don't notice the very earliest miscarriage once you have determined you are pregnant there are signs to watch for that you may be miscarrying early in your pregnancy. The Mayo Clinic, notes the most common early symptoms and signs of a miscarriage, also known as a spontaneous abortion, include:
- Vaginal bleeding
- Lower abdominal pain
- Passing tissue or fluid through the vagina
Vaginal bleeding is the major early symptom of a miscarriage, occurring in 15 to 25 percent of pregnancies in the first trimester, according to ACOG. The bleeding can be constant or intermittent, and the amount might depend on the weeks of your pregnancy.
Bleeding does not always mean a pregnancy loss is inevitable. The American Pregnancy Association states bleeding occurs in 20 to 30 percent of all pregnancies, and about half of these progress to normal, full-term delivery. Call your doctor or midwife if you notice any type of bleeding, but especially if you have the following:
- Dark brown or pink staining, or spotting of bright red blood on underwear
- Small to moderate amounts dark or bright red blood, with or without clots or tissue-like material
- Heavy bleeding that soaks through more than one sanitary pad an hour
- Bleeding that starts suddenly and come in gushes
- Increasing amounts of bleeding
Note that brief vaginal bleeding can occur early at the time of implantation. Later in pregnancy, any bleeding might indicate an inflammation or infection of the cervix, not necessarily a miscarriage.
Lower Abdominal/Pelvic Pain
Some mild lower abdominal/pelvic cramping with vaginal spotting can occur at implantation and during early gestation as your uterus adapts to your pregnancy. However, persistent intermittent or continuous cramps or pain can be an early symptom of a miscarriage.
Pelvic cramps or pain may accompany vaginal bleeding and might be due to opening of the cervix and/or uterine contractions. The intensity of pain varies but consider the strong possibility of an inevitable miscarriage if you have:
- Moderate to severe pelvic cramping or pain that is worse than your typical menstrual cramps
- Accompanying lower back pain
- Persistent pain throughout the day
- Vaginal bleeding with the pain
Call your doctor for persistent, strong, or worsening symptoms, whether or not it is accompanied by vaginal bleeding.
Passage of Tissue, Fluid or Mucus
If there is a threat of a miscarriage, in addition to vaginal bleeding you may notice the following:
- Passage of bloody or white-pink mucus material that looks like tissue; it might be hard for you to decide if this represent parts of the pregnancy (fetal or placental tissue) from small blood clots
- A sudden gush or slow leaking of fluid from your vagina, especially during the second trimester, might be cause for concern
The Mayo Clinic reference cited above advises you put any tissue-like material in a clean container to preserve it for medical examination. Seek prompt medical attention if you note passage of tissue or fluid from your vagina.
A Chemical Pregnancy Loss
Chemical pregnancies never reach a stage of viability and are often lost soon after fertilization or implantation. With a chemical pregnancy loss, you might have early spotting, but most women are unaware of this type of pregnancy or its loss. Consider the possibility if you have heavier vaginal bleeding than a normal at the time of your expected next period or a few days later.
Other Symptoms and Signs
In addition to the above main early alerts of a miscarriage, you might notice changes in common pregnancy-related symptoms and signs. Consult with your doctor if you have any of the following:
- Diminishing morning sickness: Abrupt or gradual disappearance of morning sickness might mean the pregnancy stopped developing and will miscarry, although it is normal for this symptom to decrease as your pregnancy advances.
- Decreasing breast tenderness: An early sign of pregnancy, breast tenderness might decrease or disappear early with an impending miscarriage.
- Lack of a fetal heartbeat: Not finding a fetal heartbeat on early ultrasound at six weeks of pregnancy or after, or loss of a previously established heartbeat, signifies a non-viable fetus that might miscarry before medical intervention.
- Unexplained weight loss: Increasing weight gain after the second trimester is normal, and weight loss during this time might signal a non-viable pregnancy which is soon to miscarry.
Medical Attention and Evaluation
Chemical pregnancies and other early miscarriages before six weeks often don't require medical treatment. However, even if your pregnancy is early, see your doctor or seek prompt medical care if you have moderate to severe vaginal bleeding or pain.
Bear in mind spotting or irregular vaginal bleeding, or one-sided pelvic or lower abdominal pain can be a sign of an ectopic pregnancy. This can rupture and cause an emergency at any moment, so don't delay in consulting your doctor for these symptoms,
Depending on your history, your doctor might suggest an evaluation to gain insight into the cause of your pregnancy loss and the chance of a recurrence. The extent of your evaluation will depend on your weeks of pregnancy and how many times you have miscarried.
Causes of an Early Miscarriage
Usually, the cause of a miscarriage is unknown. Many experts agree that babies who would be born with serious physical or developmental disabilities are often miscarried. KidsHealth.org also suggests miscarriages occur because an egg just didn't develop correctly.
Many women feel that they might have done something to prevent a miscarriage, such as eat healthier, but usually there's nothing they could have done. Rarely are miscarriages directly related to a mother's actions.
Miscarriages Are Common
Note that miscarriages are a common reality of pregnancy. Approximately 10 to 12 percent of recognized pregnancies end in a miscarriage, according to a review of studies by the Global Library on Women's Medicine. If unrecognized (preclinical) losses, or chemical pregnancies, are included, the percentage of miscarriages is higher.
Support for Early Miscarriage
A miscarriage, during any stage of pregnancy, can bring up feelings of anger or sadness. People deal with loss in various ways. Sometimes, people may act like it's less of a loss than losing a baby to a later miscarriage or after the birth. An early miscarriage can be devastating though. If you need support, there are some groups that can help:
If you're very depressed, it's always a good idea to talk to your care provider or a counselor.
Be Aware of Your Symptoms
Because miscarriages are common in pregnancy, it is important to learn the early symptoms and signs and pay attention if they occur. This will help you know when it is important to seek medical attention.