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Pregnancy loss & early Call your provider

Miscarriage

Also known as Early pregnancy loss, Spontaneous abortion. Before 20 weeks, most often in the first trimester.

If you are reading this in the middle of it, start here: a miscarriage is almost never caused by anything you did. It is the loss of a pregnancy before 20 weeks, the most common complication of early pregnancy, which makes it no less painful. Most happen because the pregnancy carried a chromosomal problem from the very start, something no amount of rest, caution, or worry could have changed. This page covers what is happening, what is normal, and the signs that mean you should be seen right away.

Know the warning signs When to call a provider
How common
10% to 20% of known pregnancies
Even higher counting losses before a period is missed.
When
Before 20 weeks
About 80% happen in the first trimester.
Urgency
Call your provider
Heavy bleeding or fever is an emergency.
Outlook
Reassuring
About 87% of people who miscarry go on to a healthy pregnancy.

Understanding it

What is miscarriage?

Somewhere between 10% and 20% of known pregnancies end in miscarriage, and the real figure runs higher, because many losses come so early they pass as a slightly late period. This did not happen only to you. It is common, just rarely spoken about openly, which is part of why it feels so isolating.

In the great majority of first-trimester losses, a chromosomal error occurred as egg and sperm combined. The pregnancy could not develop, and the body recognized that. Roughly half to two-thirds of early miscarriages trace to these random errors, which are not inherited, not a sign of ill health, and not something screening could have caught in time.

So many people carry unearned guilt, so let me be plain: miscarriage is not caused by exercise, sex, working, lifting, stress, an argument, or a cup of coffee. Doctors have looked hard for these links; they are not there. The one factor that clearly matters, and that no one controls, is the chance of a chromosomal error, which climbs with age.

A miscarriage unfolds in different ways. Some begin with spotting a scan shows is no threat. Others announce themselves with cramping and heavier bleeding. Sometimes there are no symptoms at all, and the loss is found at a routine scan. Whatever the path, there are safe ways to manage it, and real reason for hope about future pregnancies.

Symptoms

What are the symptoms?

Vaginal bleeding and cramping are the usual signs, though bleeding early in pregnancy does not always mean a miscarriage is happening. What matters is the amount of bleeding and whether there are signs of heavy blood loss or infection.

Early signs

  • Vaginal spotting or bleeding, light or heavy
  • Cramping or pain in the lower belly or back
  • Fluid or tissue passing from the vagina
  • A dark-colored vaginal discharge
  • A loss of pregnancy symptoms, such as nausea or breast tenderness, in a missed miscarriage

Emergency signs — call 911

  • Soaking through more than two pads an hour for two hours in a row
  • Passing large clots along with heavy bleeding
  • Fever, chills, or a foul-smelling discharge, which can signal an infection
  • Severe or worsening belly pain
  • Feeling faint, dizzy, or lightheaded

Why it matters

Risks to you and baby

Heavy bleeding

As tissue passes, bleeding can become heavy. Usually it is manageable, but soaking more than two pads an hour for two hours running is a reason to be seen urgently, and rarely needs a procedure or, very rarely, a transfusion.

Retained tissue

If some tissue stays in the uterus (an incomplete miscarriage), it can cause prolonged bleeding or infection, treatable with medication or a short procedure to empty the uterus.

Infection

An uncommon but serious complication is a uterine infection (a septic miscarriage), signaled by fever, chills, pain, and a foul discharge. It is a medical emergency needing antibiotics and prompt removal of any remaining tissue.

The emotional toll

Grief after a miscarriage is real and can be profound, and it follows no set timeline. Sadness, guilt, anger, and relief can all coexist. Support, from a partner, a counselor, or a pregnancy-loss group, is part of healing, not a luxury.

How it's found

How is it diagnosed?

A miscarriage is confirmed with ultrasound and, when needed, blood tests. A single visit is not always enough early on, because a pregnancy may simply be earlier than dates suggest.

Transvaginal ultrasound

Checks for a fetal heartbeat and whether the pregnancy is growing. Set criteria, such as an embryo of a certain size with no heartbeat, confirm a loss.

Serial beta-hCG blood tests

Tracks the pregnancy hormone over 48 to 72 hours. Falling levels support a loss and help rule out an ectopic pregnancy.

Pelvic exam

Checks whether the cervix has begun to open and looks for the source and amount of bleeding.

When you have bleeding or cramping, or when a routine scan raises concern. If the picture is unclear, your provider may repeat the scan or bloodwork in a few days rather than rush a diagnosis.

Treatment

How is it managed?

Once a miscarriage is confirmed, there are three safe ways to manage it. The right choice depends on how far along you are, how much has already passed, your health, and your own preferences.

Treatment paths

Expectant management lets the miscarriage complete on its own, usually within a few weeks. Medical management uses medication to help the tissue pass on a more predictable timeline. Surgical management is a short procedure, a suction dilation and curettage, or D&C, to empty the uterus; it is the fastest and the one used urgently for heavy bleeding or infection. None is safer than the others for a routine loss, so your preference matters.

Medication

The medicine used is misoprostol, sometimes preceded by mifepristone, which makes it more effective. It brings on cramping and bleeding to pass the tissue, usually within a day or two.

Monitoring

Afterward your provider confirms the uterus is empty and bleeding is settling. If you are Rh negative, your provider will discuss a Rho(D) immunoglobulin (RhoGAM) injection. Follow-up is also a chance to talk about grief and next steps.

Can it recur?

For most people, a miscarriage is a one-time event: about 87% go on to a normal pregnancy. The risk of another is around 20% after one, 28% after two, and higher after three or more. Repeated loss (two or more by some groups, three or more by others) is uncommon, about 2% of people, and worth a workup for a treatable cause. Even after several losses, the odds of eventually carrying a healthy pregnancy stay good.

What you can do

Can it be prevented?

  • Most miscarriages cannot be prevented

    Because the common cause is a random chromosomal error, there is usually nothing that could have stopped it and nothing you can do to prevent the next from that cause.

  • Tend to your health before and between pregnancies

    Folic acid, keeping conditions like diabetes and thyroid disease well controlled, a healthy weight, and avoiding smoking, alcohol, and recreational drugs support a healthy pregnancy overall.

  • Let go of the false causes

    Normal exercise, sex, work, and everyday stress do not cause miscarriage. Carrying guilt for these does no good and is not deserved.

Who is more at risk

Risk factors

Maternal age
The dominant risk factor, because the chance of a chromosomal error rises with age.
Roughly 9% to 17% at ages 20 to 30, about 20% at 35, 40% at 40, and up to 80% by 45
A previous miscarriage
Having had one loss slightly raises the risk of another, though most people who miscarry once do not miscarry again.
Certain health conditions
Uncontrolled diabetes, thyroid disease, and some autoimmune or clotting disorders can increase risk, which is why these are checked after repeated losses.
Uterine or cervical differences
The shape of the uterus or a weakened cervix can play a role in some losses, especially later ones.
Smoking, alcohol, and drug use
These are associated with higher risk and are worth stopping before conception.

Do not wait

When to call your provider or 911

  • Go to the ER for heavy bleeding, soaking more than two pads an hour for two hours, or passing large clots with dizziness or faintness.
  • Seek emergency care for fever, chills, or a foul-smelling discharge, which can signal a uterine infection.
  • Call your provider for any bleeding or cramping, even light, so it can be checked.
  • Call if bleeding after a known miscarriage does not settle over several days, or stops and turns heavy again, a sign of retained tissue.
  • Reach out if the emotional weight feels like too much. Grief support is care, and it is available.

Talking to your team

Questions to ask your provider

  • Is this a threatened miscarriage that might still continue, or has the loss already happened?
  • Which management option (expectant, medical, or surgical) fits my situation and my wishes?
  • If I am Rh negative, do I need a RhoGAM shot?
  • How will I know the miscarriage is complete, and what follow-up do I need?
  • How long should I wait before trying to conceive again?
  • Given my history, do you recommend any testing before my next pregnancy?
  • Where can I find grief or pregnancy-loss support?

Keep reading

More on miscarriage

All pregnancy guides articles

Good to Know

Miscarriage FAQs

Common questions about miscarriage, answered.

Did I cause this?

No. The most common cause is a chromosomal error present from conception. Exercise, sex, work, lifting, and stress do not cause miscarriage. The guilt so many people feel is real, but not deserved.

Will I be able to get pregnant again?

Almost certainly. About 87% of people who miscarry go on to a normal pregnancy. A single loss does not mean anything is wrong with your fertility.

How long should I wait before trying again?

Physically, many providers say you can try again once your body recovers, often after one normal cycle, though guidance varies. Emotionally, the right time is personal. Give yourself permission to grieve first.

Do I have to have a D&C?

Not necessarily. Many miscarriages complete on their own or with medication. A D&C is one safe option, and the right choice for heavy bleeding, infection, or when you prefer it managed quickly. The decision is often yours.

What does the bleeding look like, and how much is too much?

It can range from spotting to heavy flow with clots and cramping, often heavier than a period. The warning line is soaking more than two pads an hour for two hours in a row, which means you should be seen right away.

How many miscarriages are considered recurrent?

Some groups define recurrent loss as two or more, others as three or more consecutive losses. Either way it is uncommon, about 2% of people, and a reason to see your provider for testing, not a sign that a healthy pregnancy is out of reach.

Was it something in my diet or a medication?

Very unlikely. Ordinary foods, caffeine in normal amounts, and routine activities are not causes. Review any prescription medications with your provider, but do not assume a common early loss came from something you ate or did.

Is it normal to feel this sad?

Yes. A miscarriage is a real loss, and grief after one can be intense. There is no correct timeline and no need to minimize it. Support from a counselor or a pregnancy-loss group helps, and reaching for it is a sign of strength.

Medically Reviewed · Updated

Reviewed by Dr. Grace Lin, MD, FACOG · OB-GYN

Obstetrician-gynecologist focused on reproductive and sexual health for women: pregnancy, BV, yeast, trichomoniasis and HPV/cervical screening. Our editorial guidelines →

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