Knowing the signs of a possible miscarriage is critical for pregnant women. Miscarriages are the most common form of pregnancy loss, and generally occur before the 20th week of pregnancy. So how do you know if you’re experiencing a miscarriage? Some of the signs and symptoms are clear-cut, while others can be confused with other pregnancy symptoms.
Just because you don’t experience the normal symptoms of pregnancy doesn’t mean that you will have a miscarriage. Some women do not feel nausea or breast tenderness. Some women do not crave weird foods. Each woman and each pregnancy is unique. Knowing your body during pregnancy may be a challenge, especially for first-timers.
Knowing what signs to look for to detect a miscarriage at its beginning may help prevent the miscarriage and possibly prevent future miscarriages from occurring (although sometimes there isn’t any sign of a miscarriage at all). The most common signs of miscarriage include:
- Vaginal bleeding: Bleeding occurs at some point in 70 percent of all pregnancies, but this is the number one sign of an incipient miscarriage, especially if it occurs in the first 12 weeks. It’s very important that you understand the difference between spotting and bleeding, and if you see what appears to be an excessive amount of blood, you should go to the doctor to have yourself and your baby examined. Usually brown spotting or faint pink spotting with mucus is far less a concern that red bleeding like a menstrual period.
- Cramping: Cramping during pregnancy is very common, even with low-risk pregnancies, especially in the first couple of months. It pretty much comes with the territory. However, if you have cramps and bleeding, if the cramps are very painful, or if there is also severe back pain, you should take this as a warning sign that a miscarriage may be starting.
- Loss of pregnancy symptoms: If you suddenly notice a decrease in pregnancy symptoms, and you’re still in the stages during which you should be having these symptoms, you may want to contact your doctor. The absence of nausea and breast tenderness, or significant weight loss during the early weeks, are possible signs of a miscarriage.
- Lower back pain: Back pain during pregnancy is almost universal. But severe back pain, especially when there are other problems such as bleeding and cramping, is not okay. It’s a very common warning sign of a miscarriage, especially if the pain begins in the lower abdomen and pelvic area and moves to the lower back.
- Abdominal pain: Generally, low-level abdominal pain is not a reason to panic, unless the pain is severe and coupled with cramping and/or bleeding. There could be a number of reasons why you’re experiencing abdominal pain, including miscarriage. If you’re worried, contact your doctor.
- Vaginal pressure or low pelvic pressure: This is one of those vague symptoms. Mild pressure is normal, but too much might be the first sign of a weakening of the cervix (a condition known as incompetent cervix, or IC). One reason to suspect IC is significant vaginal pressure, a sensation like something is trying to fall out of the vagina or something is pushing into the vaginal canal; this sensation is stronger when you stand and better when you lie down. Another possible warning sign is increased vaginal discharge or watery vaginal discharge. Please contact your doctor right away if you have this.
- Labor contractions: If you begin feeling painful labor contractions before 20 weeks of pregnancy and they are happening more than two or three times per hour, you should call your doctor immediately. Painful contractions should not be confused with Braxton Hicks contractions. The biggest difference is that Braxton Hicks contractions are irregular in timing and generally do not cause pain. They can begin as early as six weeks into your pregnancy, but they are infrequent and irregular. Labor contractions early in your pregnancy are a sign of possible miscarriage or possible incompetent cervix. (Read more about incompetent cervix here.)
Signs of Miscarriage vs. Length of Pregnancy
Some of the signs of miscarriage depend on how long you’ve been pregnant. To help you, we’ve put together some guidelines:
- 0 – 6 Weeks Pregnant: Some women who are a week or two late for a period do not realize that they are pregnant. If they miscarry, it may just feel like a very heavy and painful period. Sometimes the only way to know if whether you’ve had a miscarriage or not is to check a pregnancy test right when it is occurring. One to two weeks later the pregnancy test will be negative, and then there is no way to know if you’ve had a miscarriage or just a late, heavy period.
- 6 – 12 Weeks Pregnant: You may experience pelvic pain, cramping, or bleeding. The bleeding may start out as light spotting, but then over the course of a few hours or a day or two it may increase until it is heavier than even a heavy period. Mild cramps may also be present, and these may get stronger as the bleeding gets heavier.
- 12 – 20 Weeks Pregnant: You may think you’re experiencing labor during the miscarriage due to the intense pain and bleeding. Or sometimes the water bag breaks without any signs of bleeding or labor. This also can be due to Incompetent Cervix (see IC above).
Whenever a pregnant woman has bleeding in the first trimester, she needs to be evaluated. Often the bleeding is light, and an ultrasound reveals that the baby appears to be fine. This is a threatened miscarriage. There is still a chance that this condition will progress to an actual miscarriage, but there is also a very good chance that with rest and some time, this will resolve and the pregnancy will continue normally.
Who Should Watch For Signs of a Miscarriage?
All women should watch for signs and symptoms of a miscarriage or incompetent cervix the same way they would watch for symptoms of an illness like the flu. Miscarriages occur in approximately 20 percent of all pregnancies. Normally a miscarriage occurs in the first trimester, and rarely after reaching the second.
Incompetent cervix tends to occur in the second trimester. Warning signs include vaginal pressure, low pelvic pressure, a sensation that something is trying to come out or fall out through the vagina, increased vaginal discharge or watery vaginal discharge.
Prevention of Miscarriage
The reality of miscarriage is that it is quite common, occurring on average in about one out of six pregnancies, and that the great majority of miscarriages cannot be prevented. This is because most miscarriages are due to abnormal fetal DNA that was present at conception. Studies show that this is not abnormal DNA inherited from the mother or father (with rare exceptions). This is abnormal DNA that was present or developed after the sperm and egg fused.
Progesterone hormone supplements (which are very safe because only bio-identical progesterone is used) are used by many doctors early in pregnancy to try to prevent miscarriages. Not all doctors believe that progesterone even works, but most have come around. Here’s why:
In a minority of cases, low progesterone levels associated with an otherwise normal fetus may be the cause of first-trimester spotting and cramping (a threatened miscarriage). It is reasonable to use bio-identical progesterone to try to treat this condition, even though we know that most of the time it will not prevent the miscarriage. Some doctors “don’t believe” in progesterone, but if a doctor says this and the patient miscarries, she is pretty likely to switch doctors for the next pregnancy. It was more important for this doctor to be “right” than to try to help a desperate patient, even if there is little actual evidence to support the use of progesterone in the prevention of miscarriage.
Early diagnosis of an incompetent cervix is imperative if the pregnancy is to be saved. If an 18-weeks pregnant patient shows up with her water broken and 3 centimeters dilated, that pregnancy is almost impossible to save. If the cervix is 1–2 centimeters dilated and the water bag is intact, there is a good chance that a rescue cerclage (a stitch placed in the cervix) by an experienced obstetrician can save that pregnancy, but time is of the essence in this type of situation.
Learn more about miscarriage here.