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Pregnancy loss & early Call your provider

Threatened Miscarriage

Also known as Threatened abortion. First half of pregnancy, before 20 weeks.

The word threatened lands like a verdict, but it is only a warning. It means bleeding in the first half of pregnancy while the cervix stays closed and the pregnancy is still viable on ultrasound. Bleeding this early is common, affecting roughly 1 in 4 pregnancies, and most of the time it settles and the pregnancy continues. Once a heartbeat has been seen, the odds swing strongly in your favor.

Know the warning signs When to call a provider
How common
Bleeding affects ~1 in 4 pregnancies
Threatened miscarriage is a common subset of early bleeding.
When
Before 20 weeks
Most often in the first trimester.
Urgency
Call your provider
Any bleeding warrants a call; heavy bleeding is urgent.
Outlook
Most continue
About 89% continue once a heartbeat is seen.

Understanding it

What is threatened miscarriage?

A threatened miscarriage is bleeding before 20 weeks in a pregnancy that is still going: the cervix closed, the pregnancy viable on ultrasound. It is one of early pregnancy's most common frights, because bleeding feels like the worst news. But bleeding and loss are not the same thing.

Roughly a quarter of pregnancies bleed in the first trimester, and most carry on. In one study, about 60% with early bleeding delivered at term. And once a heartbeat is seen, only about 11% end in loss, meaning nearly 9 in 10 continue.

Often no cause is found. The most common identifiable one is a subchorionic hemorrhage, a small pool of blood beside the sac that usually clears on its own. When a threatened miscarriage does become a loss, the reason is almost always a chromosomal problem in the embryo, not the bleeding and not anything you did. Exercise, sex, and normal activity do not cause it.

No treatment reliably stops it, and bed rest, which has been studied, does not help. Care is mostly watchful waiting: confirming the pregnancy is continuing and knowing the signs that mean you should be seen. Most people who have one go on to a healthy birth.

Symptoms

What are the symptoms?

The sign is bleeding, usually light to moderate, sometimes with mild cramping, in a pregnancy that is otherwise continuing. What matters is how heavy the bleeding is and whether it is progressing.

Early signs

  • Light to moderate vaginal bleeding or spotting
  • Mild, dull cramping in the lower belly or back
  • A closed cervix on exam
  • An otherwise normal pregnancy, with a heartbeat, on ultrasound

Emergency signs — call 911

  • Heavy bleeding, soaking one to two pads an hour for two or more hours
  • Severe or sharp cramping or belly pain
  • Passing clots or tissue
  • Feeling faint, dizzy, or lightheaded
  • One-sided pelvic pain with bleeding, which needs an ectopic pregnancy to be ruled out

Why it matters

Risks to you and baby

Progression to miscarriage

A minority progress to an actual loss. Once a heartbeat has been seen, the risk drops to around 11%.

The strong likelihood it continues

This is the most likely outcome. Most pregnancies with early bleeding continue, and a confirmed heartbeat is very reassuring.

A modestly higher chance of later complications

Even when the pregnancy continues, a threatened miscarriage is linked to a slightly higher chance of preterm birth, early water breaking, growth restriction, or placental abruption later on. That is why your provider may keep a closer eye on things.

The emotional strain

Waiting to learn whether a pregnancy will continue, while bleeding, is genuinely hard. Anxiety is normal, and it is fair to lean on support through the uncertainty.

How it's found

How is it diagnosed?

It is confirmed by a pelvic exam showing a closed cervix and an ultrasound confirming the pregnancy is viable, usually a heartbeat.

Pelvic exam

Checks whether the cervix is closed (threatened) or has begun to open (the loss progressing), and the amount and source of bleeding.

Transvaginal ultrasound

Confirms the pregnancy is in the uterus and viable, often by showing a heartbeat, and may reveal a subchorionic hemorrhage as the source of the bleeding.

Serial hCG blood tests

When viability is uncertain, tracking the hormone over a couple of days helps confirm the pregnancy is developing and rule out an ectopic.

Whenever bleeding occurs before 20 weeks. If it is too early to see a heartbeat, your provider may repeat the scan or bloodwork rather than rush a conclusion.

Treatment

How is it managed?

There is no treatment that reliably stops it, and most continue on their own. Care is watchful waiting and knowing the warning signs.

Treatment paths

Management is expectant. Bed rest does not prevent loss and is not recommended. Pelvic rest, avoiding sex and tampons while you bleed, is often advised, though evidence for it is limited. For someone with a prior loss who is now bleeding, vaginal progesterone may modestly improve the chance the pregnancy continues.

Monitoring

A repeat ultrasound confirms the pregnancy is continuing. Because a threatened miscarriage carries modestly higher later risks, your provider may watch your baby's growth more closely as pregnancy goes on.

Can it recur?

Bleeding can happen again, here or in a future pregnancy, but it is not itself a recurring disease. If you are Rh negative and bleeding, you may need a RhoGAM injection.

What you can do

Can it be prevented?

  • It cannot be stopped once it starts

    There is no proven way to halt a threatened miscarriage, and bed rest does not help. If a pregnancy is going to continue, it usually does on its own; if a chromosomal problem is ending it, nothing changes that.

  • Support the pregnancy generally

    A prenatal vitamin with folic acid, and managing conditions like thyroid disease and diabetes, support a healthy pregnancy overall, though they cannot prevent bleeding.

  • Get RhoGAM if you are Rh negative

    If you are Rh negative and bleeding, a Rho(D) immunoglobulin injection protects a future pregnancy from Rh problems.

Who is more at risk

Risk factors

It can happen to anyone
A threatened miscarriage can occur in any pregnancy regardless of age or health, so there is often no clear reason.
Older maternal age
The chance that early bleeding reflects a chromosomal problem, and progresses to loss, rises with age.
A subchorionic hemorrhage
A collection of blood by the pregnancy sac is a common cause of the bleeding; large ones carry a somewhat higher risk of loss.
A previous miscarriage
A prior loss modestly raises the risk and is the reason progesterone is considered for some people who bleed.

Do not wait

When to call your provider or 911

  • Call your provider for any bleeding, even light spotting, so it can be checked.
  • Seek urgent care for heavy bleeding, soaking one to two pads an hour for two or more hours, or for passing clots or tissue.
  • Go in for severe or sharp cramping, or if you feel faint, dizzy, or lightheaded.
  • Seek care for one-sided pelvic pain with bleeding, which needs an ectopic pregnancy ruled out.
  • Reach out if the uncertainty is weighing on you. Support during the wait is worthwhile.

Talking to your team

Questions to ask your provider

  • Has a heartbeat been seen, and what does that mean for my chances?
  • Is my cervix closed, and is the pregnancy in the right place?
  • Do you see a subchorionic hemorrhage, and does its size matter?
  • Given my history, would vaginal progesterone help?
  • What bleeding or pain should send me in right away?
  • If I am Rh negative, do I need a RhoGAM shot?

Keep reading

More on threatened miscarriage

All pregnancy guides articles

Good to Know

Threatened Miscarriage FAQs

Common questions about threatened miscarriage, answered.

Does bleeding mean I am losing the pregnancy?

Not usually. Bleeding this early is common, and most of these pregnancies continue. It is a reason to get checked, not the end of the story.

What are my actual chances the pregnancy continues?

Very good once a heartbeat is confirmed: only about 11% end in loss from that point, so roughly 89% continue. Before a heartbeat is seen the range is wider, which is why a scan is so reassuring.

Did I do something to cause the bleeding?

Almost certainly not. It is not caused by exercise, sex, lifting, or normal activity. Often no cause is found, and when one is, it is usually a harmless subchorionic hemorrhage.

Should I be on bed rest?

No. Bed rest has been studied and does not prevent miscarriage. Your provider may suggest pelvic rest, avoiding sex and tampons while you bleed, though even that has limited evidence.

Is there anything that can stop it?

No treatment reliably stops it. If the pregnancy is healthy, it usually continues on its own. For someone with a prior loss who is bleeding, vaginal progesterone may help modestly.

What is a subchorionic hemorrhage?

A collection of blood between the pregnancy membranes and the uterine wall, from a small area of separation. It is a common, usually harmless cause of early bleeding; most clear on their own, and larger ones may be watched with a follow-up scan.

When should I go to the emergency room?

For heavy bleeding, soaking one to two pads an hour for two or more hours, for passing clots or tissue, for severe cramping, or if you feel faint. One-sided pain with bleeding also needs urgent evaluation to rule out an ectopic.

Will this affect the rest of my pregnancy?

Usually not, but a threatened miscarriage is linked to a modestly higher chance of some later complications, such as preterm birth. Because of that, your provider may monitor your baby's growth a bit more closely.

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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