A Missed Miscarriage

Learn How a Doctor Makes This Diagnosis

Woman with abdominal cramps
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A miscarriage is a type of pregnancy loss that occurs in the first 20 weeks of gestation, usually in the first trimester. In a miscarriage, the baby has stopped developing. The term "missed miscarriage" refers to a situation in which a woman is having a miscarriage but is not yet having clear miscarriage symptoms, such as vaginal bleeding, cramping in the abdomen or lower back, and the passing of tissue through the vagina. 

How Is a Missed Miscarriage Diagnosed?

In a missed miscarriage, a doctor usually discovers the condition during a routine prenatal checkup. He or she may make the diagnosis based on a few different types of exams. 

One common blood test that a doctor gives a woman during early pregnancy checks her level of human chorionic gonadotropin (hCG), a hormone that is produced by the body during pregnancy. During the first few weeks of pregnancy, a woman's hCG level is expected to double every two to three days. If that number isn't rising quickly during that timeframe, it may or may not be a cause for concern. If that number has stopped rising or is actually dropping during that time span, that's more concerning. Two consecutive blood tests in early pregnancy that show a decreasing hCG level is most likely a sign of miscarriage. 

Another red flag appears if an ultrasound (also known as a sonogram) reveals that a baby's heartbeat has stopped. An ultrasound is an exam that uses high-frequency sound waves to project an image of the fetus onto a screen. 

Another clue that a woman is having a missed miscarriage is when the fetus's heartbeat fails to become audible on a fetal heart rate monitor by 12 weeks of gestation.

What Happens After a Missed Miscarriage Is Diagnosed?

After a missed miscarriage diagnosis, a woman often faces a choice of whether or not to seek intervention for the miscarriage. If bleeding has not yet started, a natural miscarriage, (also known as a miscarriage without intervention) might take days or weeks to begin, so look out for symptoms. Many women with this diagnosis opt for a surgical procedure called a dilation and curettage (D&C) in order to have the ordeal over with as quickly as possible. In the first trimester, it's usually called a D&A (dilation and aspiration), because the doctor dilates your cervix and then uses a tool called a suction curette (as opposed to a sharp curette) to gently empty the uterus. 

Why Do Missed Miscarriages Occur?

Like most first-trimester miscarriages, the usual cause of a missed miscarriage is a chromosomal abnormality in the developing baby. These chromosomal abnormalities are random in nature and after one miscarriage, a woman has a roughly 85% chance of having her next pregnancy be healthy and normal. 

Some missed miscarriages are due to a condition called blighted ovum. In a blighted ovum, the gestational sac and placenta continue to develop but the baby does not. A woman might continue to experience pregnancy symptoms, but then the baby's heartbeat never becomes audible on a heart rate monitor and an ultrasound ultimately reveals an empty gestational sac.

If you've had more than one miscarriage, multiple pregnancy losses sometimes have other causes. Women with recurrent miscarriages should talk to a doctor about what sort of testing may help you figure out the underlying problem (if there is one). 

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