Diagnosis of a Miscarriage Without Bleeding

It is possible to detect a miscarriage (other related terminology includes "blighted ovum," "spontaneous abortion," and "missed miscarriage") with no bleeding or cramping—though these symptoms generally follow eventually. Diagnosing a miscarriage before symptoms occur is becoming more common with the use of quantifiable pregnancy hormone (hCG) blood tests and early ultrasound exams.

Common Symptoms of Miscarriage

The most commonsign associated with miscarriageis bleeding (though it's important to note that not allspotting or bleeding in early pregnancyis indicative of miscarriage). The initial bleeding associated with miscarriage can range from small amounts of brown blood to heavy bleeding with clots and tissue.

Bleeding due to miscarriage is a result of progesterone levels precipitously dropping, after which the uterine lining begins to shed. In some cases, an ultrasound will be performed to diagnose suspected miscarriage after early pregnancy bleeding. Based on gestational age and ultrasound pregnancy dating, an early ultrasound can show that the fetus was not viable up to two weeks before the actual onset of bleeding.

Other symptoms of miscarriage may include:

• Cramping or dull pain in the back or pelvis that may be constant or come and go
• Loss of common early pregnancy symptoms like morning sickness, breast tenderness, and fatigue
• Passage of fetal tissue

Missed Miscarriage

In many cases, miscarriage symptoms like bleeding are what promptdiagnostic tests like ultrasoundin early pregnancy. But the process of miscarrying can actually take a few days or even weeks, which is why it is possible for healthcare providers to detect a miscarriage even before symptoms like bleeding start.

For example, aroutine ultrasound可以发现没有胎儿心跳(表明w一致ith miscarriage) before any miscarriage symptoms like bleeding have begun. This diagnosis is known as a "missed miscarriage."

Because of the absence of common symptoms with a missed miscarriage, it's possible to have experienced pregnancy loss without knowing it.

After a Missed Miscarriage Diagnosis

After a pregnancy loss, the products of conception and the uterine lining need to pass out of the body. In most cases, this process will naturally start on its own within two weeks of a missed miscarriage diagnosis. Waiting for this miscarriage bleeding to proceed naturally is known as expectant management.

While expectant management is a reasonable option for some, the uncertainty associated with waiting while continuing to carry a nonviable pregnancy can take an emotional toll.

As a result, when a miscarriage diagnosis is confirmed before bleeding has begun, interventions may be offered. Rather than waiting, some people opt for a surgical procedure known asdilation and curettage (D&C)or medical management with a medication calledCytotec (misoprostol).

These interventions make the physical process of miscarrying more predictable, minimizing the waiting period associated with allowing the miscarriage to progress naturally. For some, getting the physical process of miscarrying "over with" with medical intervention helps the grieving process. Others prefer to allow the miscarriage to progress naturally.

As long as your doctor has no medical concerns, there is no single management method for missed miscarriage that is considered best, and in most cases, you will be given the option to choose the method you feel most comfortable with.

Expectant Management	Medically Induced Miscarriage	Surgical Intervention
Least invasive	Minimally invasive	Most invasive; may be performed outpatient or may require general anesthesia
Least expensive	Low cost	Most costly
可以emotionally challenging to wait	May require some waiting time for the drug to take effect	Can be done at the time you choose
Moderate to heavy bleeding and cramping	Heavy bleeding and moderate to severe cramping; mild side effects may include nausea, vomiting, and diarrhea	Moderate bleeding and cramping
If unsuccessful (known asincomplete miscarriage), a D&C may be necessary	If unsuccessful (which is rare), a D&C may be necessary	Rare complications include uterine adhesions (Asherman's syndrome), cervical damage, or uterine perforation
		Allows for genetic testing of the fetal tissue if indicated

A Word From Verywell

The possibility of miscarrying without immediately knowing can be a major source of anxiety in early pregnancy—especially if you've experienced pregnancy loss before. In most cases, there isn't anything anyone could have done to affect the outcome of a missed miscarriage, but that knowledge doesn't minimize the initial shock and grief.

一旦你决定你想如何管理体育sical aspects of your loss—whether expectant management or medical intervention—be sure that you also address your emotional well-being. Some find it helpful to talk to others who have faced a similar situation, either among their friends or through amiscarriage support organization. Others look to their partner for support or seek help from a therapist. However you choose to process your grief, know that you are not alone, and that is does get better.