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Pregnancy loss & early Call your provider

Missed miscarriage

Also known as Missed abortion, Silent miscarriage, Delayed miscarriage. First trimester, usually found on a routine scan.

There is often no bleeding, no cramping, no sign at all. In a missed miscarriage the pregnancy has stopped, but the body has not yet recognized it, so many people still feel pregnant. It usually surfaces at a routine ultrasound that finds no heartbeat. Learning it this way, without warning, is a particular kind of shock. It is not your fault, and it does not mean you cannot have a healthy pregnancy.

Know the warning signs When to call a provider
How common
A form of early miscarriage
Miscarriage ends about 10% to 20% of known pregnancies.
When
First trimester
Often found at a dating or reassurance scan.
Urgency
Call your provider
Not usually an emergency; heavy bleeding or fever is.
Outlook
Reassuring
Most people go on to have a healthy pregnancy.

Understanding it

What is missed miscarriage?

The pregnancy has ended and the embryo or fetus is no longer developing, but the body has not begun to pass the tissue. The cervix stays closed, bleeding and cramping never start, and hormones can linger, so you may still feel pregnant. That is why it is sometimes called a silent miscarriage: nothing signals that anything has changed.

With no symptoms to warn you, it is usually found at a routine ultrasound showing no heartbeat, or a pregnancy that has not grown. Hearing this at what you thought was a happy appointment is one of the hardest ways to get the news, and the grief that follows deserves care.

As with most first-trimester losses, the cause is almost always a chromosomal error present from the start. It is random, not something you caused, and not a sign of a problem with your body or fertility. Roughly half to two-thirds of early miscarriages trace to these chromosomal problems.

It is managed like other early losses, with the same safe options and reassuring outlook, and most people who have one go on to a healthy pregnancy. Because the diagnosis is so consequential, your provider confirms it carefully before recommending treatment.

Symptoms

What are the symptoms?

The defining feature is the absence of symptoms: usually no bleeding, no cramping, the loss found on a scan. When symptoms do appear, they are those of an early miscarriage starting on its own.

Early signs

  • Often no symptoms at all
  • Pregnancy symptoms, such as nausea or breast tenderness, that fade
  • No fetal heartbeat on ultrasound
  • Sometimes light spotting or mild cramping if the loss begins to pass

Emergency signs — call 911

  • Heavy bleeding, soaking 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 or dizzy

Why it matters

Risks to you and baby

The pregnancy has ended

A missed miscarriage is a confirmed loss: no heartbeat, no way to restart the pregnancy. Naming it and grieving it is part of moving through, and having had no warning makes it no less real.

Heavy bleeding when the tissue passes

Whether it happens on its own or with treatment, bleeding can be heavy as the tissue passes. Soaking more than two pads an hour for two hours running, or feeling faint, is a reason to be seen urgently.

Retained tissue and infection

If tissue remains in the uterus, it can cause prolonged bleeding or, uncommonly, an infection with fever and pain. Both are treatable with medication or a short procedure.

The emotional weight of a silent loss

Learning of a loss at a scan, while still feeling pregnant, is its own kind of grief. Shock, disbelief, and sadness are all normal, and support is worth reaching for.

How it's found

How is it diagnosed?

It is diagnosed by transvaginal ultrasound. Because the diagnosis is so important, strict size criteria apply, and a repeat scan is often done to be certain before any treatment.

Transvaginal ultrasound

Shows no fetal heartbeat, or a pregnancy that has not grown. Confirmatory findings include an embryo 7 mm or more with no cardiac activity, or an empty sac 25 mm or more across.

Follow-up ultrasound

When findings are early or borderline, a repeat scan in about a week showing no development confirms the loss, so a viable pregnancy is never ended by mistake.

hCG blood tests

Pregnancy hormone levels that plateau or fall, rather than rising, support the diagnosis.

Usually at a routine first-trimester scan, or when symptoms fade. Providers confirm the diagnosis, sometimes with a second scan, before recommending treatment.

Treatment

How is it managed?

It is managed with the same three safe options as other early losses. Because no symptoms force the timeline, you often have time to consider which fits best.

Treatment paths

Expectant management waits for your body to pass the tissue, which can take days to a few weeks, sometimes longer here since the process has not started. Medical management uses medication to bring it on more predictably. Surgical management is a short procedure, a suction dilation and curettage, to empty the uterus; it is the fastest option and the one used for heavy bleeding or infection.

Medication

The medicine used is misoprostol, often preceded by mifepristone, which makes it more effective. If you are Rh negative, you should receive a Rho(D) immunoglobulin (RhoGAM) injection.

Monitoring

Afterward your provider confirms the uterus is empty and bleeding is settling, and follow-up is a chance to talk about grief and next steps.

Can it recur?

For most people it is a one-time event, and the great majority go on to a normal pregnancy. The risk of another loss rises with the number of prior losses, but even after several, the odds of eventually carrying a healthy pregnancy stay good. Two or more are worth an evaluation.

What you can do

Can it be prevented?

  • It cannot be prevented

    Because the cause is a random chromosomal error, there was nothing you could have done to prevent it, and nothing reliably prevents one from that cause.

  • Support your health before and between pregnancies

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

  • Get RhoGAM if you are Rh negative

    This does not prevent the loss, but it protects a future pregnancy from Rh problems, so make sure it is given if it applies to you.

Who is more at risk

Risk factors

Maternal age
The dominant factor, because the chance of a chromosomal error rises with age.
Roughly 9% to 17% at ages 20 to 30, rising to 75% to 80% by 45
A previous miscarriage
Having had a loss modestly raises the risk of another, though most people who miscarry once do not miscarry again.
Certain health conditions
Uncontrolled diabetes, thyroid disease, and some uterine or autoimmune conditions can increase risk, which is why these are checked after repeated losses.

Do not wait

When to call your provider or 911

  • Call your provider to discuss your options once it is confirmed, and to arrange follow-up.
  • Go to the ER for heavy bleeding, soaking more than two pads an hour for two hours, or if you feel faint or dizzy.
  • Seek urgent care for fever, chills, or foul-smelling discharge, which can signal infection.
  • Call if bleeding after treatment does not settle over several days, or stops and turns heavy again, a sign of retained tissue.
  • Reach out if the loss is weighing on you. Grief support is care, and it is available.

Talking to your team

Questions to ask your provider

  • Are you certain the pregnancy has ended, or should we repeat the scan to be sure?
  • 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?

Keep reading

More on missed miscarriage

All pregnancy guides articles

Good to Know

Missed miscarriage FAQs

Common questions about missed miscarriage, answered.

How could this happen with no symptoms?

The pregnancy stops developing, but the body does not begin to pass the tissue. The sac stays put and hormones linger, so there is no bleeding or cramping and you may still feel pregnant. It is common, and not a sign anything was missed.

Did I do something to cause it?

No. The usual cause is a random chromosomal error present from the start. It is not caused by exercise, sex, stress, work, or anything you did or did not do.

Why do I still feel pregnant?

Because pregnancy hormones can linger after the pregnancy stops. Still feeling pregnant does not mean the diagnosis is wrong, which is why providers confirm it carefully, sometimes with a second scan.

Why might I need a second ultrasound before treatment?

To be absolutely certain. Sometimes a pregnancy is just earlier than the dates suggest, so if findings are borderline, a repeat scan showing no development confirms the loss and protects a normal pregnancy from being ended by mistake.

Do I have to have a procedure?

Not necessarily. A missed miscarriage can be managed by waiting, with medication, or with a short procedure. Because no symptoms rush the timeline, you often have time to choose, unless there is heavy bleeding or infection.

How is this different from a blighted ovum?

Both are early losses found on a scan. In a blighted ovum, a sac forms but an embryo never develops. In a missed miscarriage, an embryo developed and then stopped. The management and outlook are the same.

Will I be able to have a healthy pregnancy?

Most likely, yes. About 87% of people who miscarry go on to a normal pregnancy. A missed miscarriage is not a sign of infertility, and one loss does not mean the next will end the same way.

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. Ask your provider, and allow yourself room to grieve.

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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