Diagnosis of a Miscarriage Without Bleeding

Pregnancy loss may be diagnosed even before symptoms occur

Quick facts about missed miscarriages

Verywell / Ran Zheng 

It is possible to have a miscarriage (other common terminology includes "blighted ovum," "spontaneous abortion," and "missed abortion") with no bleeding or cramping. However, these typical symptoms will eventually follow most of the time. While it sounds unlikely, diagnosing a miscarriage before symptoms occur is becoming more common with the advent of quantifiable pregnancy hormone blood tests and early ultrasound.

Bleeding and Other Symptoms of Miscarriage

The most common sign associated with miscarriage is bleeding. The bleeding can be variable, ranging from small amounts of brown blood to heavy bleeding with clots and tissue. Bleeding occurs when products of conception pass from the uterus through the cervix and vagina.

Besides bleeding, the other symptoms of miscarriage include:

  • Cramping or dull pain in the back or pelvis that may be constant or come and go
  • Passage of fetal tissue—which might resemble meat or liver
  • Very early loss of morning sickness, breast tenderness, fatigue, and other common signs of early pregnancy (keep in mind that morning sickness typically goes away early in the second trimester)

If you experience any of these signs or symptoms—even if bleeding is absent—contact your physician right away.

Missed Miscarriages

Bleeding from a miscarriage is due to progesterone levels precipitously dropping. At this point, a woman's uterine lining will begin to shed and bleeding will begin; fetal tissue may pass at this time. This can take a few days or weeks, which is why ultrasounds performed after early pregnancy bleeding will often show that the fetus was not viable one to two weeks before the actual onset of bleeding. In other instances, a routine ultrasound will detect no fetal heart beat—consistent with miscarriage—before any symptoms are noted.

The Symptom Timeline and Medically Induced Miscarriage

In many cases, bleeding starts on its own within two weeks following miscarriage. Many women opt for surgical invention (D&C) or medically induced miscarriage once the diagnosis has been confirmed, preferring to get the physical aspect of the miscarriage over with as quickly as possible and minimize the anxiety and anticipation of waiting.

Expectant management, meaning waiting for the miscarriage to occur naturally, is also a reasonable option for reliable patients.

For most people, there is no single method which is considered best, and people are often given the option to choose the method they feel most comfortable with. If you are facing this decision, here are some of the pros and cons to consider.

Advantages
  • Watchful waiting is the least invasive approach and may feel more "natural" for some women. It also has a cost advantage over other methods.

  • Cytotec (misoprostol) medically-induced miscarriage is less invasive than surgery but more invasive than watchful waiting—a kind of "in between" approach. Most people are able to do this as an outpatient. While successful for most women, those who fail to complete miscarrying will need a D&C.

  • With a D&C, the removal of the products of conception can be done at the time you choose, and you will be able to return to your life more quickly (usually). A D&C also allows for genetic testing of the fetal tissue if indicated.

Disadvantages
  • With watchful waiting you have to wait to pass the fetal tissue, which can be emotionally and physically challenging. Moderate to heavy bleeding and cramping may occur. In addition, people who choose watchful waiting may end up having an unplanned D&C.

  • Cytotec has some mild side effects such as nausea, vomiting, and diarrhea. The medication doesn't work instantly, so it may take some time before the miscarriage is complete. Like watchful waiting, a woman may experience bleeding that is heavier than menses and moderate to severe cramping.

  • D&C is the most invasive of the methods and can be done under general anesthesia (with the risks of anesthesia) in an operating room, or sometimes in an office setting. Rarely, women may develop uterine adhesions (Asherman's syndrome), which could lead to problems with infertility. There is also a very small risk of damage to the cervix or uterine perforation. This is also the most costly of the methods.

The risks are quite comparable among the approaches—significant bleeding and/or infection may occur with all three (although this is rare).

The big picture here is that when it comes to managing a miscarriage, a doctor will mostly consider your preference.

A Word From Verywell

A possible missed miscarriage is scary for any pregnant woman. However, the majority of pregnancies continue without these complications. Sadly, in most cases (especially in the first trimester), there isn't anything anyone can do to affect this outcome.

If you are feeling anxious about your pregnancy, talk with your doctor for further guidance. If you learn that you've had a miscarriage, it can be a challenging time as you cope with the physical treatments in addition to the emotions of loss.

Reach out to family and friends. Some people find it very helpful to talk to others who have faced a similar situation, either among their friends or through one of the many support organizations designed to help people cope with pregnancy loss.

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