What is a missed miscarriage?

Missed miscarriages are a form of pregnancy loss in which a fetus fails to develop, but a woman’s body doesn’t recognize the loss and the pregnancy tissue is not expelled. Missed miscarriages are uncommon, occurring in about one percent of all pregnancies, but when they happen, they can be devastating.

Why do they happen?

The majority of missed miscarriages occur in the first 12 weeks of pregnancy. This type of pregnancy loss often happens as a result of chromosomal abnormalities with the embryo, for example if the embryo has too many or too few chromosomes. Abnormalities like these make it impossible for the body to continue the pregnancy. In other cases, a missed miscarriage occurs for unknown reasons.

What are the symptoms?

Women who experience a missed miscarriage usually don’t have typical miscarriage symptoms like bleeding or pain. In most cases, the miscarriage goes undetected until a woman’s next appointment. Some women still experience pregnancy symptoms, which can happen if the placenta continues releasing the hormones that cause pregnancy symptoms. Unfortunately, the presence of pregnancy symptoms can make a missed miscarriage diagnosis that much more surprising.

How is a missed miscarriage diagnosed?

Most women discover that they have miscarried at their regular check-up, when the provider notices an underdeveloped embryo or a lack of fetal heartbeat in the ultrasound. To make sure there isn’t a heartbeat, the provider will send the woman to a radiologist for confirmation. The provider will also probably take a blood test to measure hCG levels (the hormone that is produced during pregnancy). If these are low and there’s no heartbeat to be found in the ultrasound, the provider will diagnose a missed miscarriage.

How is a missed miscarriage treated?

With a missed miscarriage, the body still has to expel pregnancy tissue, so after a diagnosis the next step is determining a way to remove this tissue. A provider might recommend any of the following for treatment.

  • Wait and let the tissue expel naturally: Women may choose this option if they want to let the pregnancy end on its own, or if they don’t yet want to take medical or surgical action. This is not an option after eight or nine weeks, however. 
  • Medical treatment: Women can take a drug called misoprostol that helps the body expel the tissue. This might be preferable for women who are very early in their pregnancy, or for women who prefer treatment that is less invasive than a D&C.
  • Surgical treatment: A provider might recommend a dilation and curettage (D&C) if a missed miscarriage occurs after eight or nine weeks. For this procedure, the woman is put under anesthesia, her cervix is dilated, and the provider uses a thin instrument to remove the pregnancy tissue from the uterus. 

What comes after treatment?

Women who have been treated for a missed miscarriage should wait one menstrual cycle before trying again to conceive. It’s entirely likely, though, that women who experience a missed miscarriage will want some time to grieve before trying again. Miscarriages can be devastating, and this kind of miscarriage is made more painful by the fact that it often comes as a complete surprise, and sometimes happens for an unknown reason. 

It takes some women a long time to recover from the loss, although the healing process is different for everyone. What is the same for every woman in this situation is that due to the traumatic nature of a missed miscarriage, as well as the hormone changes that take place during and after a miscarriage and make a woman vulnerable to postpartum depression, it’s important for women to find a way to process their feelings or reach out to someone who can support them while they grieve.

  • Linda W. Prine, Honor Macnaughton. “Office Management of Early Pregnancy Loss.” Am Fam Physician. 84(1):75-82. Web. Jul 2011. 
  • “Miscarriages.” KidsHealth. Nemours Foundation, Jun 2015. Web.

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