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 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 as medical practitioners run earlier routine ultrasounds and checks.

Bleeding and Other Symptoms of Miscarriage

The most common sign associated with miscarriage is bleeding. The bleeding can be variable at the start, ranging from small amounts of brown blood to heavy bleeding. 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—looks like a white solid mass covered in blood
  • Very early loss of morning sickness (keep in mind that morning sickness typically goes away by the fifth month of pregnancy)

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

Missed Miscarriages

When a miscarriage is diagnosed without bleeding, a situation called missed miscarriage is sometimes described. The reason why the miscarriage is referred to as "missed" is that the body has not yet recognized that a woman is no longer pregnant.

Bleeding from a miscarriage rarely begins the instant the fetus is no longer viable, but rather after the mother's hormone levels drop—a signal to the body that the pregnancy can no longer continue. At this point, a woman's uterine lining will begin to shed and bleeding will begin (similar to a menstrual cycle). This can take a few days or weeks, which is why ultrasounds performed after early pregnancy bleeding will often show that the baby was deceased one to two weeks before the actual onset of bleeding.

But if an ultrasound is performed for some other reason, such as a routine check for a heartbeat, it is possible for the ultrasound to detect that the baby has miscarried before the mother has begun to have any miscarriage symptoms, and she may even still feel pregnant.

The Symptom Timeline and Medically Induced Miscarriage

In most cases, the miscarriage bleeding would start on its own within two weeks following the diagnosis. But given the uncertainty of the time range and the emotional aspects of carrying a nonviable pregnancy, many moms opt for a 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.

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

For most people, there is no single method which is considered best, and people are often told 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.


  • 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).


  • 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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