Early miscarriage

An early miscarriage is the loss of a pregnancy before the 12th week, and it's the most common type of miscarriage.

If the loss happens between 12 and 24 weeks, doctors call it a late miscarriage.

The signs of early miscarriage can be mistaken for normal symptoms of pregnancy. They can include:

• vaginal bleeding
• stomach pain or cramping
• pregnancy symptoms suddenly stopping

Having these symptoms doesn't mean you're definitely having an early miscarriage. But if you're concerned, speak with a doctor or call the 16263 health line.

Vaginal bleeding can vary. It may be light spotting or brown discharge. It can also be a heavier bleed that's similar to (or heavier than) your normal period.

Light bleeding and spotting before 12 weeks of pregnancy is common, and it's often not a sign of miscarriage. But you should always seek help if you bleed at any point in your pregnancy, whether or not you're in pain. Contact your maternity unit, a doctor or the 16263 health line.

If you're bleeding, use a clean sanitary pad or period pants. Do not use tampons or period cups, because they can increase the risk of infection.

It's a good idea to keep an eye on the bleeding and make a note of what it's like, so you can tell your doctor, nurse or midwife. Think about how much there is, what colour it is, and whether there are any big lumps or clots.

Some stomach pain or light cramps in early pregnancy are not unusual. They can be caused by:

• your uterus (womb) expanding
• your ligaments stretching as your bump grows
• hormones
• constipation
• trapped wind

However, cramping and pain in your lower abdomen (tummy) may be a sign of miscarriage. If any pain worries you, contact your maternity unit, a doctor or the 16263 health line.

If you have a miscarriage, you may find your pregnancy symptoms disappear. For example, you stop feeling sick, or your breasts are no longer tender. These symptoms can also disappear after your first trimester, though.

If you're concerned about your pregnancy symptoms stopping, contact your maternity unit, a doctor or the 16263 health line.

• have sharp, sudden and intense stomach pains
• feel very dizzy or faint
• feel very sick
• look very pale
• have vaginal bleeding or spotting, commonly after the pain has started
• have pain in your shoulder tip
• have diarrhoea and are vomiting

• you're bleeding from your vagina
• you've got strong, cramping pain
• your waters break

Often it isn't possible to say why an early miscarriage happened. It's unlikely that anything you did or didn't do caused it.

Once an early miscarriage has started, there's no way to stop it. There are different treatments that can help you manage it, though, and the one you're offered will depend on what type of miscarriage you're having.

The doctor, nurse or midwife treating you will do an ultrasound scan to confirm which type it is.

In a complete miscarriage, the pregnancy comes away from the womb by itself. Once this is confirmed, you won't need to stay in hospital, and you can manage your symptoms at home.

You'll be given advice on over-the-counter painkillers. It's normal to bleed for up to 3 weeks after a miscarriage, so you'll need extra-absorbent sanitary products. External ones, like pads or period pants, are recommended. Internal products, like tampons, increase the risk of infection.

You're advised to take a pregnancy test 2 to 3 weeks after your miscarriage. This makes sure the miscarriage is complete.

A missed miscarriage happens when you've lost your pregnancy without having any symptoms. Because of this, there's a risk that pregnancy tissue is left in the womb. An incomplete miscarriage is when some of your pregnancy is left in your womb.

If pregnancy tissue stays in the womb, it can cause an infection and make you very unwell.

There are 3 options for managing a missed or incomplete miscarriage. The people treating you will talk through them with you, and you'll be given time to decide what you'd like to do.

You may want someone with you at this time. That's possible with every type of management, though if you need or choose surgery, they may not be able to stay with you during it. The people caring for you will talk this through with you.

The 3 options are expectant management, medical management and surgical management.

Expectant management

Expectant management means you wait for the miscarriage to finish by itself. This happens in about half of people who choose to wait.

You don't need to stay in hospital, but it can take some time for the bleeding to start.

You'll be given contact details for who to get in touch with if:

• you have any concerns about your health or the progress of your miscarriage
• you change your mind about your management option

You'll also be given information about what you can do with your baby's remains. You'll be offered prescription painkillers, or given advice on painkillers you can buy over the counter.

When the miscarriage does start, you'll feel cramping pain, and it may be intense. You'll bleed heavily and pass large clots.

Seek medical advice immediately if:

• you soak through more than 2 heavy flow sanitary pads per hour, for 3 hours in a row
• you develop a high temperature (fever)
• you have severe pain or cramping that you cannot manage with pain relief

You'll be asked to take a pregnancy test after 3 weeks. You may also be offered an ultrasound to check that all the pregnancy tissue has come away. If the treatment has not worked, you may be offered:

• continued expectant management
• medical management
• surgical management

Expectant management might not be recommended for you if:

• you have an increased risk of haemorrhage (severe bleeding)
• you're at increased risk from the effects of haemorrhage (severe bleeding), for example if you're unable to have a blood transfusion
• you have an infection

Medical management

With medical management you'll be given 2 tablets, called mifepristone and misoprostol. They help the pregnancy tissue to come away from your uterus (womb). Medical management works in 85 out of 100 people.

You take mifepristone first. It blocks the hormones that allow a pregnancy to continue. Then, 36 to 48 hours later, you take a dose of misoprostol. A few hours after the misoprostol, you'll start bleeding.

Some pain after taking misoprostol is normal. Everyone's experience is different, but people often:

• have cramps that are more intense than your usual period
• have heavy bleeding
• pass blood clots

The pregnancy sac will pass with the clots.

You'll be offered pain relief and anti-sickness medicine. You may also be able to take ibuprofen or paracetamol, up to the recommended safe dose. A hot water bottle or heat pack can help a little too.

In most cases you can go home while you wait for the miscarriage to complete.

Seek medical advice immediately if:

• you soak through more than 2 heavy flow sanitary pads per hour, for 3 hours in a row
• you develop a high temperature (fever)
• you've severe pain or cramping that you cannot manage with pain relief

You'll be asked to take a pregnancy test after 3 weeks. If the treatment has not worked, you may be offered further medical management. You may also be offered surgical management.

Surgical management

Surgical management means having an operation to remove the pregnancy. It works in 95 out of 100 people.

You'll be given an anaesthetic for the operation. This may be a local anaesthetic, which numbs the area but leaves you awake. Or it may be a general anaesthetic, which means you'll be asleep for the procedure.

Once the anaesthetic has taken effect, your cervix is gently opened with a small tube. Any remains of the pregnancy are then removed with a suction device.

The surgery is safe, but like any operation it carries a small risk of complications. These include:

• heavy bleeding
• infection
• damage to the womb

You should be able to go home the same day, once you've recovered from the anaesthetic. You'll be given advice on painkillers you can buy over the counter.

After a miscarriage

It's normal to bleed for up to 3 weeks after a miscarriage, so you'll need extra-absorbent sanitary products. External products, like pads or period pants, are recommended. Internal products, like tampons, increase the risk of infection.

Contact your doctor if:

• you soak through more than 2 heavy flow sanitary pads per hour, for 3 hours in a row
• you develop a high temperature (fever) and flu-like symptoms
• you have severe pain or cramping that you cannot manage with pain relief medicine, whether prescribed or bought over the counter
• you have smelly vaginal discharge
• you have increasing stomach pain, along with a fever, loss of appetite and nausea
• you feel burning and stinging when you pass urine, or you're passing urine often
• you have a leg that is painful, red, swollen or hot
• you're having difficulty bearing weight on your legs

You may be advised to have surgery straight away if:

• you're bleeding heavily and continuously
• there are signs of infection
• medicine to remove the pregnancy has been tried without success

Miscarriage can be a very upsetting experience, no matter when it happens. It may take some time to recover, both physically and emotionally, and it's important to give yourself the time you need. But if you are struggling to cope, talk to your doctor. They'll help you get more support.