When most people think of a miscarriage, they imagine how it’s shown on TV and in movies—a woman waking up in the middle of the night in bed covered in blood. While bleeding and cramping are often signs of a miscarriage, it is possible to experience a miscarriage without any symptoms at all. This is known as a missed miscarriage and it affects as many as 40 percent of all miscarriages, according to research published in the journal Human Reproduction.
All miscarriages are painful, but a missed miscarriage can feel especially cruel, since it often catches the pregnant person entirely by surprise. This lack of a physical experience can make it harder to process the loss and achieve closure. Additionally, because a missed miscarriage might not be outwardly visible, many women may feel isolated in their grief—perhaps even uncomfortable talking about it due to the sensitive nature of the topic, leading to feelings of loneliness and a lack of support.
“With a missed miscarriage, it’s as if the body hasn’t realized the pregnancy stopped growing,” says Allison Rodgers, M.D., OB/GYN, reproductive endocrinologist at Fertility Centers of Illinois. “Typically a patient goes into their provider and ultrasound reveals the pregnancy isn’t still growing or the baby doesn’t have a heartbeat.”
Imagine feeling pregnant in every way possible—you’re nauseous, you’re bloated, your pregnancy tests are dark, etc.—only to go into the first ultrasound and see life stand still on the monitor. Not only are you devastated in every way, but you’re also in a state of shock and disbelievement. That’s a missed miscarriage—and it deserves to be recognized and talked about because it happens to so many women who’ve gone through loss and it’s a unique experience in a myriad of ways.
What causes a missed miscarriage?
While the exact causes of missed miscarriage remain elusive, several factors may contribute to its occurrence. Here are a few, according to OB/GYNs:
Most of the time, nothing
Before we get into potential causes, it’s important to note that the vast majority of miscarriages are not caused by anything—but rather the body’s natural process of flushing out a pregnancy that would not be able to flourish otherwise. That can still be a hard pill to swallow for many, however, it’s important not to point the blame on yourself.
Chromosomal abnormalities
This is the most common cause of all miscarriages, accounting for as many as 90 percent of early miscarriages, per research published in the journal Nature. With a chromosomal abnormality, the embryo develops with an abnormal number of chromosomes, making it unable to develop healthily and leading to its demise. “Typically, these are whole chromosome abnormalities but can be what we call microdeletions or additions which are smaller pieces of DNA added or removed that leave the pregnancy not compatible with life,” says Dr. Rodgers.
Anatomic problems
Pregnancy is a complex process, and sometimes, anatomic problems can arise that can affect its success. Potential anatomic problems in pregnancy might include a uterine septum, where a band of tissue partially divides the uterus and hinders implantation or embryonic growth, uterine fibroids, or non-cancerous growths in the uterine wall, or a heart-shaped uterus the increases risk of miscarraige (known as a bicoruate uterus). Asherman’s Syndrome, or scarring of the uterine lining, can also be a cause, but this is more likely if the person has had prior procedures like a D&C.
Immune-related issues
The immune system’s role in miscarriage is intricate and not fully understood, and, while it can be a contributing factor, it’s not the sole cause in most cases. Normally, the immune system recognizes and tolerates a developing embryo as part of the mother’s body, explains Dr. Rodgers. However, in some cases, the immune system might mistake the embryo for a foreign object and attack it. Possible causes of immune system-related miscarriages include Antiphospholipid Syndrome (APS), an autoimmune disorder that causes the body to produce antibodies that attack healthy tissues, including those involved in pregnancy and Uterine Natural Killer (NK) Cells, immune cells that can be present in the uterus and play a role in implantation. The exact role of NK cells in miscarriage is still being researched, however, elevated levels of certain NK cells might be linked to an increased risk of miscarriage in some women, according to research.
Can someone be prone to a missed miscarriage?
There’s not a lot of research on whether someone can be prone to a missed miscarriage or whether or not you’re more likely to have a missed miscarriage if you’ve experienced one before. As mentioned, most miscarriages, including missed miscarriages, happen due to chromosomal abnormalities in the embryo that prevent healthy development. These abnormalities are random and not influenced by the mother’s health. Dr. Rodgers points out that every pregnancy and every person is different in how their body has miscarriages, but agrees that some people can be prone to missed miscarriages depending on the reason for the loss in the first place.
Signs and symptoms of a missed miscarriage
Identifying missed miscarriage can be challenging due to the absence of typical miscarriage symptoms. However, certain clues may prompt individuals to seek medical evaluation. For example, if you were experiencing early pregnancy symptoms like nausea, fatigue or breast tenderness, and they suddenly disappear, it could be a cause for concern. However, some women experience a decrease in symptoms naturally, so this alone isn’t definitive. The only surefire sign of a missed miscarriage is if a doctor cannot detect a fetal heartbeat during a routine prenatal ultrasound passed the point in which there should be one (typically around 8 weeks).
How is a missed miscarriage diagnosed?
“Typically, a patient will present to their medical provider and an ultrasound may show that the pregnancy isn’t as far along as you expected or thought, or that a baby that had a heartbeat no longer does,” says Dr. Rodgers. “These typically occur in the 6–8-week range but can happen earlier or later, and often a repeat ultrasound is performed to check for pregnancy changes.” The reason for the second check, she explains is because sometimes people get pregnant later than they thought, and the pregnancy isn’t as far along as they believe. A repeat scan in 1-2 weeks show can show whether or not the pregnancy has progressed.
What are some treatment options for a missed miscarriage?
Following a missed miscarriage diagnosis, you’ll have treatment options to discuss with your doctor. Here’s a breakdown of the three main approaches:
Observation
“You can wait until your body figures out that the baby is no longer growing and progress with a miscarriage naturally,” says Dr. Rodgers. “If this goes on too long (weeks or months) there can be an increased risk of infection, or more rarely Disseminated Intravascular Coagulation (DIC), a serious medical condition where abnormal blood clotting occurs throughout the body’s blood vessels, so its important to be monitored by your doctor closely.”
Medication
This method involves using certain medications to help the body expel the pregnancy tissue.
The two medications commonly used are Mifepristone, which blocks the hormone progesterone which is essential for maintaining the pregnancy, and Misoprostol, which helps soften the cervix and stimulate contractions, allowing the body to pass the tissue naturally. Most people will use one of two, both of which are safe and effective. “These medications have a low chance of any type of complications, but sometimes with natural or medication miscarriages, there can be excessive bleeding which needs to be evaluated and treated in the emergency or operating room,” says Dr. Rodgers. “These medications also have very little side effects and no long term complications.”
Medication is most successful as a treatment for a pregnancy that halted early on. At 8 weeks or less, it works about 94-98 percent of hte time, and at 10-11 weeks, it works 87 percent of the time, according to Planned Parenthood.
Surgical management
Some people require—or opt—to have surgery to remove the pregnancy, called a D&C or dilation and curettage. This is an outpatient procedure performed under anesthesia and it’s very safe. During a D&C, a doctor uses gentle suction and surgical instruments to remove any remaining pregnancy tissue from the uterus. Some people prefer this method of miscarriage management, since it tends to be more efficient and faster removal of tissue, typically completed within 30 minutes. It also provides a clearer picture of the uterine lining for future pregnancy planning.
How to navigate the emotional challenges of a missed miscarriage
Dr. Rodgers has been through her own share of missed miscarriages and notes that there is certainly both the physical trauma of a miscarriage, but also, the emotional trauma. “It’s not just the loss of the six-week pregnancy you are grieving, but the child you were dreaming of and planning for from the moment you found out you were pregnant,” she says.
She recommends first allowing yourself to grieve the loss of the child you wanted. “It’s normal to feel grief, which can be challenging to navigate with partners sometimes,” she says. “Your partner can feel grief, but also feel that they need to be there for you and should be strong for you.” It’s important to remember that everyone grieves in different ways and it’s normal for it to take a varying amount of time.
Allow yourself to feel your emotions—sadness, anger, confusion and even guilt, all of which are common after a loss. Try talking to your partner, family members, friends or a therapist, which can provide a safe space to express your emotions and feel supported. Connecting with others who have experienced similar losses can be incredibly helpful. Sharing your story and listening to others can provide a sense of understanding and belonging.
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