Signs and Risks of a Threatened Miscarriage

Pregnant Woman Having An Ultrasound
vgajic / Getty Images
Table of Contents
View All
Table of Contents

During the early stages of pregnancy, there may be symptoms or sensations that don’t seem right to you. It may be something you can’t put your finger on or a feeling that things are not proceeding as they should. At other times, there may be bleeding or abdominal pain that in no way seems normal. Your first instinct may be to assume the worst: that you are experiencing a miscarriage.

If this is the case, there are things your doctor can do to either confirm or rule out your suspicions. One of the more common complications in early pregnancy is a condition known as threatened miscarriage, or threatened abortion.

What Is a Threatened Miscarriage?

"Threatened miscarriage" is a term used to describe abnormal bleeding and abdominal pain that occurs while the pregnancy still continues. While vaginal bleeding is common during early pregnancy, anything other than spotting during the first trimester may be considered a threatened miscarriage.

The bleeding and pain will typically be mild, while the opening of the cervix (cervical os) will ideally be closed. A dilated cervix, by contrast, is an indication of an inevitable miscarriage.

Threatened miscarriage occurs in 20% of all pregnancies before 20 weeks of gestation.

While most people will go on to deliver their babies without incident, as many as one in seven will experience further complications, and sometimes a miscarriage is the result.


While it is not always possible to know what causes a threatened miscarriage, there are some factors that can indicate increased risk during the first trimester. These include:

  • Alcohol and/or drug use
  • Chromosomal problems with the fetus
  • Excessive caffeine intake (over 200 milligrams per day)
  • Exposure to certain medications or chemicals
  • Obesity
  • Older age (threatened miscarriage is most common in women over 40)
  • Problems with the placenta
  • Smoking
  • Trauma to the abdomen

Threatened miscarriage during later trimesters is more commonly associated with the following:

  • High blood pressure
  • Infection
  • Kidney problems
  • Structural problems with the uterus, cervix, or ovaries
  • Thyroid disorder
  • Unmanaged diabetes

How a Threatened Miscarriage Is Diagnosed

When a threatened miscarriage is diagnosed, the doctor will order tests to assess the viability of the pregnancy. These can include an ultrasound and hCG blood tests.

The hCG blood test measures how much human chorionic gonadotropin (hCG) is in the blood. This is a hormone produced by the fetal tissue that helps stimulate the production of progesterone during the first trimester. It is key to a healthy pregnancy.

In early pregnancy, however, one hCG test is not enough. The standard of care requires at least two tests spaced two days apart to judge whether hCG levels are rising or falling.

Similarly, an ultrasound often needs to be repeated a few days or a week later in order to conclusively diagnose an early miscarriage or a missed miscarriage (where the fetus has died but the body has not yet recognized this).

Coping With the Diagnosis

If you have been diagnosed with threatened miscarriage and need to have repeat tests, you can care for yourself in a few ways during this painful period of waiting.

  • Healthy distraction: Find a good book, stream some movies, or visit with friends to fill in the gap between tests.
  • Hormone treatment: Some doctors prescribe progesterone supplements, which studies suggest might help prevent miscarriage in some cases.
  • Pelvic rest: Do not douche or insert anything (including tampons) into your vagina. Avoid sexual intercourse until symptoms are completely gone for one week.
  • Rest: Some doctors suggest bed rest while you wait for a definitive response. While rest itself will not prevent miscarriage, overexertion may needlessly add to your stress.

In most cases, symptoms will subside, and your pregnancy will continue to term. Sometimes, supportive treatments and lifestyle adjustments may be recommended to prevent further complications.

However, if the outcome is not good, it is important to remember that the miscarriage is not your fault—and it's a painful experience regardless of when it happened.

  • Allow yourself the time to grieve and the space to recover.
  • Carve out the time you need to fully recover and try not to rationalize your feelings away.
  • Call on supportive friends or join a support group.
11 Sources
Verywell Family 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. Sapra KJ, Joseph KS, Galea S, Bates LM, Louis GM, Ananth CV. Signs and symptoms of early pregnancy loss. Reprod Sci. 2017;24(4):502-513. doi:10.1177/1933719116654994

  2. Kanmaz AG, İnan AH, Beyan E, Budak A. The effects of threatened abortions on pregnancy outcomes. Ginekol Pol. 2019;90(4):195-200. doi:10.5603/GP.a2019.0035

  3. Pontius E, Vieth JT. Complications in early pregnancy. Emerg Med Clin North Am. 2019;37(2):219-237. doi:10.1016/j.emc.2019.01.004

  4. Saraswat L, Bhattacharya S, Maheshwari A, Bhattacharya S. Maternal and perinatal outcome in women with threatened miscarriage in the first trimester: A systematic review. BJOG. 2010;117(3):245-257. doi:10.1111/j.1471-0528.2009.02427.x

  5. Sotiriadis A, Papatheodorou S, Makrydimas G. Threatened miscarriage: Evaluation and management. BMJ. 2004;329(7458):152-5. doi:10.1136/bmj.329.7458.152

  6. San Lazaro Campillo I, Meaney S, Corcoran P, Spillane N, O'Donoghue K. Risk factors for miscarriage among women attending an early pregnancy assessment unit (EPAU): A prospective cohort study. Ir J Med Sci. 2019;188(3):903-912. doi:10.1007/s11845-018-1955-2

  7. Hendriks E, MacNaughton H, MacKenzie MC. First trimester bleeding: Evaluation and management. Am Fam Physician. 2019;99(3):166-174.

  8. Serdinšek T, Reljič M, Kovač V. Medical management of first trimester missed miscarriage: The efficacy and complication rate. J Obstet Gynaecol. 2019;39(5):647-651. doi:10.1080/01443615.2018.1535577

  9. Carp HJA. Progestogens and pregnancy loss. Climacteric. 2018;21(4):380-384. doi:10.1080/13697137.2018.1436166

  10. Coomarasamy A, Devall AJ, Cheed V, et al. A randomized trial of progesterone in women with bleeding in early pregnancyN Engl J Med. 2019;380(19):1815-1824. doi:10.1056/NEJMoa1813730

  11. Betts D, Dahlen HG, Smith CA. A search for hope and understanding: An analysis of threatened miscarriage internet forums. Midwifery. 2014;30(6):650-6. doi:10.1016/j.midw.2013.12.011

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