Diagnosis of a Miscarriage Without Bleeding

Quick facts about missed miscarriages

Verywell / Ran Zheng 

It is possible to detect a miscarriage (other related terminology includes "blighted ovum," "spontaneous abortion," and "missed miscarriage") with no bleeding or cramping—though these symptoms generally follow eventually. Diagnosing a miscarriage before symptoms occur is becoming more common with the use of quantifiable pregnancy hormone (hCG) blood tests and early ultrasound exams.

Common Symptoms of Miscarriage

The most common sign associated with miscarriage is bleeding (though it's important to note that not all spotting or bleeding in early pregnancy is indicative of miscarriage). The initial bleeding associated with miscarriage can range from small amounts of brown blood to heavy bleeding with clots and tissue.

Bleeding due to miscarriage is a result of progesterone levels precipitously dropping, after which the uterine lining begins to shed. In some cases, an ultrasound will be performed to diagnose suspected miscarriage after early pregnancy bleeding. Based on gestational age and ultrasound pregnancy dating, an early ultrasound can show that the fetus was not viable up to two weeks before the actual onset of bleeding.

Other symptoms of miscarriage may include:

  • Cramping or dull pain in the back or pelvis that may be constant or come and go
  • Loss of common early pregnancy symptoms like morning sickness, breast tenderness, and fatigue
  • Passage of fetal tissue

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

Missed Miscarriage

In many cases, miscarriage symptoms like bleeding are what prompt diagnostic tests like ultrasound in early pregnancy. But the process of miscarrying can actually take a few days or even weeks, which is why it is possible for healthcare providers to detect a miscarriage even before symptoms like bleeding start.

For example, a routine ultrasound may detect no fetal heartbeat (a sign consistent with miscarriage) before any miscarriage symptoms like bleeding have begun. This diagnosis is known as a "missed miscarriage."

Because of the absence of common symptoms with a missed miscarriage, it's possible to have experienced pregnancy loss without knowing it.

After a Missed Miscarriage Diagnosis

After a pregnancy loss, the products of conception and the uterine lining need to pass out of the body. In most cases, this process will naturally start on its own within two weeks of a missed miscarriage diagnosis. Waiting for this miscarriage bleeding to proceed naturally is known as expectant management.

While expectant management is a reasonable option for some, the uncertainty associated with waiting while continuing to carry a nonviable pregnancy can take an emotional toll.

As a result, when a miscarriage diagnosis is confirmed before bleeding has begun, interventions may be offered. Rather than waiting, some people opt for a surgical procedure known as dilation and curettage (D&C) or medical management with a medication called Cytotec (misoprostol).

These interventions make the physical process of miscarrying more predictable, minimizing the waiting period associated with allowing the miscarriage to progress naturally. For some, getting the physical process of miscarrying "over with" with medical intervention helps the grieving process. Others prefer to allow the miscarriage to progress naturally.

As long as your doctor has no medical concerns, there is no single management method for missed miscarriage that is considered best, and in most cases, you will be given the option to choose the method you feel most comfortable with.

Expectant Management Medically Induced Miscarriage Surgical Intervention
Least invasive Minimally invasive Most invasive; may be performed outpatient or may require general anesthesia
Least expensive Low cost Most costly
Can be emotionally challenging to wait May require some waiting time for the drug to take effect Can be done at the time you choose
Moderate to heavy bleeding and cramping Heavy bleeding and moderate to severe cramping; mild side effects may include nausea, vomiting, and diarrhea  Moderate bleeding and cramping
If unsuccessful (known as incomplete miscarriage), a D&C may be necessary If unsuccessful (which is rare), a D&C may be necessary Rare complications include uterine adhesions (Asherman's syndrome), cervical damage, or uterine perforation
    Allows for genetic testing of the fetal tissue if indicated

A Word From Verywell

The possibility of miscarrying without immediately knowing can be a major source of anxiety in early pregnancy—especially if you've experienced pregnancy loss before. In most cases, there isn't anything anyone could have done to affect the outcome of a missed miscarriage, but that knowledge doesn't minimize the initial shock and grief.

Once you've decided how you want to manage the physical aspects of your loss—whether expectant management or medical intervention—be sure that you also address your emotional well-being. Some find it helpful to talk to others who have faced a similar situation, either among their friends or through a miscarriage support organization. Others look to their partner for support or seek help from a therapist. However you choose to process your grief, know that you are not alone, and that is does get better.

1 Source
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  1. Condous G. Ultrasound diagnosis of miscarriage: new guidelines to prevent harmAustralas J Ultrasound Med. 2011;14(4):2. doi:10.1002/j.2205-0140.2011.tb00127.x

Additional Reading

By Krissi Danielsson
Krissi Danielsson, MD is a doctor of family medicine and an advocate for those who have experienced miscarriage.