Everything you need to know about missed miscarriages

Missed miscarriages are spontaneous events that mark the premature end of a pregnancy that may already have been deeply invested in. Unfortunately, they remain a topic that is barely talked about, with its share of unknowns, so here is some information to help you better understand them and cope with them if needed.

Missed miscarriages: let’s take a closer look.

Missed miscarriages: what are they?

This is a spontaneous end of an ongoing pregnancy. In other words, for one of the reasons we will discuss later, the pregnancy that began in the uterus will stop developing naturally.

Missed miscarriages: at what stage of pregnancy?

• Early missed miscarriages: they occur before the 14th week of amenorrhea (14 weeks without a period or 12 weeks of pregnancy). Some may even go unnoticed, since they happen in the very first days and may be mistaken for a slightly late period. This is therefore a phenomenon considered common in medicine, but it also means that the vast majority of pregnancies continue normally!
• Late missed miscarriages: much rarer (less than 1% of pregnancies), they occur between the 14th and the 22nd week of amenorrhea (weeks without a period). Beyond 22 weeks, we no longer speak of miscarriage but of preterm birth to describe the expulsion of the fetus.

Why do they happen, and can they be prevented?

In most cases, missed miscarriages are the result of natural processes that cannot be controlled. Here are a few reasons that may be at the origin of missed miscarriages:

• Abnormalities in embryo development account for most causes of missed miscarriage: in the great genetic lottery, certain incidents occur at key stages of embryo formation, and if it is not viable, it will naturally stop developing. These abnormalities may be linked to chromosomal malformations that are incompatible with continuing the pregnancy.
• An ectopic pregnancy : this pregnancy is automatically not viable. It requires urgent care when it does not end spontaneously and calls for close medical monitoring.

• There is also the particular case of a “blighted ovum”: the membranes and placenta develop, but no embryo has formed. Pregnancy hormones are therefore indeed present (a positive test and symptoms felt), but unfortunately the pregnancy will not progress.
• Factors related to your health can also affect how a pregnancy progresses: poorly controlled pre-existing chronic diseases (such as diabetes, hypothyroidism, clotting disorders, hormonal issues) or abnormalities of the uterus and cervix. In that case, it is important to plan appropriate medical follow-up beforehand to stabilize the condition and prepare for pregnancy under the best possible conditions.
• Finally, certain external factors are associated with an increased risk of missed miscarriage: the use of drugs, alcohol, and tobacco, for example (specialized teams exist for these issues—do not hesitate to contact them if you feel you are struggling with them). This is also the case with excessive caffeine/theine (keep the pleasure of your morning coffee if you really need it, but try to cut back during the day, and switch to herbal tea in the evening!). Good to know: hormonal contraception, such as the pill, does not increase the risk of a later miscarriage.
• On the other hand, contrary to certain common beliefs, regular, appropriate physical activity (avoid weightlifting and climbing Mont Blanc, for example) is associated with a decreased risk of miscarriage. If you’re used to it, don’t deprive yourself of your weekly sessions! And if exercise wasn’t a regular part of your routine: walk! This habit is very beneficial throughout pregnancy.

Good to know: as menopause approaches, the risk of missed miscarriage naturally increases due to a decline in egg quality.

The (rare) cases of recurrent missed miscarriages

Chance, sometimes harsh, can strike the same body several times without any clear explanation. However, beyond 3 missed miscarriages, it is recommended to look for a possible cause behind these sad repetitions. Is there a condition that could explain these recurrences?

Several blood tests and examinations will be carried out to find answers and offer you appropriate care.

If you have any questions on the topic, feel free to download the May app, where you’ll find plenty of resources to support you.

How to recognize a miscarriage?

The signs of a miscarriage can be confusing, as they sometimes overlap with normal early-pregnancy symptoms.

Symptoms of miscarriage

The well-known early pregnancy symptoms vary greatly from one woman to another, so it is difficult to rely on them completely. However, the symptoms most commonly described in a missed miscarriage are as follows:

• Bleeding: light or heavy, red, pink, or brown, watery or with clots (small masses of coagulated blood).

Watch out for hemorrhage: in the event of heavy bleeding (= a pad quickly soaked and needing to be changed several times within 30 minutes): have someone accompany you to the emergency room or contact emergency services so you can be taken there quickly.

• Pelvic pain, reflecting uterine contractions, which may feel similar to the pain sometimes experienced during your period.

Note that these symptoms can also occur during the normal course of pregnancy, and likewise some miscarriages happen silently… so how can you tell, and what test can reassure you—or unfortunately reveal that the pregnancy has stopped?

How missed miscarriages are diagnosed

A transvaginal ultrasound (an ultrasound performed using a probe inserted into the vagina) makes it possible to locate a pregnancy in the uterus, date it, and detect embryonic cardiac activity as early as the first weeks—and therefore its absence if applicable. Thanks to this examination, repeated over several days if needed, we can determine whether there is an ongoing pregnancy and whether it is developing or not.

If there is doubt on this ultrasound, especially if the pregnancy is still in its very early stages, we can also compare the progression of a pregnancy hormone (called beta-hCG) through a series of blood tests done 48 hours apart, to determine whether the pregnancy is continuing or not. The tests should be done at the same laboratory for better reliability of results.

Good to know: a transvaginal ultrasound makes it possible to measure the cervix and visualize the uterus and ovaries. It is performed using an elongated, rounded probe with a diameter of less than 2 cm, covered with a latex sheath similar to a condom and coated with ultrasound gel (cold!).

You will be positioned lying down or slightly reclined, with knees bent, and the midwife or gynecologist will gently insert the probe into the vagina and move it slightly to obtain images of the uterus from different angles. This procedure obviously requires your agreement and consent.

What happens when you experience a missed miscarriage?

When a miscarriage is diagnosed, appropriate medical care may be offered to ensure your safety, limit complications, and support you as best as possible physically and emotionally.

Missed miscarriage: what medical management?

A miscarriage can happen spontaneously. In that case, the pregnancy ends on its own, and you may experience uterine contractions and bleeding that can be more or less heavy. It is recommended to have an ultrasound afterward to check that the uterus is empty and that the miscarriage is complete.

If an ultrasound diagnoses that a pregnancy has stopped developing early on, you may be offered to wait for the expulsion to happen spontaneously (but this can take time and may still require an intervention), so two options may be offered:

• Surgical treatment: just like a voluntary termination of pregnancy (abortion), it consists of suctioning the gestational sac from the uterus. This procedure takes place in the operating room under local or general anesthesia. In the vast majority of cases, it does not require hospitalization.
• Medication treatment: given orally or vaginally, it aims to trigger uterine contractions to expel the gestational sac. A follow-up ultrasound about ten days later checks that the miscarriage is complete. If it is not, one of these two methods may be offered again.

Whether your miscarriage happened spontaneously or required treatment, do not hesitate to ask for pain relief, and to request medical leave afterward if you feel you need it. Unfortunately, care is still far too limited and sometimes traumatic for you. Let’s hope progress is rapid and significant in the months and years ahead.

Good to know: the law of July 7, 2023, among other measures, introduced sick leave with no waiting period for women who have experienced a missed miscarriage.

One reassuring point: the risks of these situations remain minimal, and future fertility is unchanged (no increased risk of infertility). Missed miscarriages can, however, leave a psychological mark, because a pregnancy that stops—even early on—is never trivial. We recommend that you lean on someone you trust so you are not alone with the sensations and feelings you may experience. Do not hesitate to talk about it, because it is a loss to grieve, and like any loss, it sometimes takes time.

Missed miscarriages: how to cope afterward?

The direct physical consequences of a missed miscarriage are very often minimal. If you are considering a new pregnancy project immediately afterward, medical professionals generally encourage you to go ahead. Even after a missed miscarriage, ovulation usually returns quickly. There is no specific waiting period as such—it’s mostly when you feel ready.

However, the psychological impact of such an experience is not insignificant: depression and anxiety are frequently described symptoms, and addressing this aspect seems essential.

Sometimes resuming intercourse can also be complicated—something happened in your body, and it’s normal to feel apprehensive about these steps. Don’t hesitate to talk about it; midwives or doctors who specialize in sexology can help you.

For many of you, this is grieving a projection—often a pregnancy that is invisible to others—making it harder to confide in people. You may go through many feelings, all legitimate, whether apathy, anger, confusion, deep sadness, or isolation. Do not remain alone with these feelings:

• Surround yourself in particular with a medical and allied-health team you trust (OB-GYN, midwife, psychologists) to ensure follow-up.
• Talk with your partner about your own experiences. People sometimes process things on different timelines; we don’t all move forward at the same pace, and what feels “in the past” for one person isn’t always for the other.
• Don’t be afraid to confide in those around you. You may find a supportive ear in a friend who has been through the same thing.
• If your close circle feels too awkward or you feel uncomfortable confiding in them, there are also support groups. The Agapa association in particular supports patients who have experienced a missed miscarriage.
• In addition, more and more women are sharing their stories on social media or through podcasts, helping to break the silence that traditionally surrounds these losses. For example, you can look at @mespresquesriens or listen to @aurevoir.podcast.

A word from Anna Colombiès, psychologist:

“There are many types of follow-up care that can help you cope with a missed miscarriage. You can also reach out to the perinatal networks in your region to obtain the names of professionals specialized in this area.”

Missed miscarriages are common events—often unpredictable and deeply challenging, both physically and emotionally. Every experience is unique and valid, and no path to healing looks the same. Getting medical and psychological support, surrounding yourself with others, and daring to talk about it are all keys to getting through this ordeal and, when the time comes, looking ahead again with confidence.

And finally: take care of yourself and your body, which is where you will need to rebuild full confidence. And don’t hesitate to express your pain if it helps: write, draw, dance, make small and big plans—in short, move forward but at your own pace!

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Photo credits: Sonyachny | Mgrsanko

This text was translated from French by an artificial intelligence. The information, advice, and sources it contains comply with French standards and may therefore not apply to your situation. Make sure to complement this reading by visiting the May US/UK app and consulting the healthcare professionals who are supporting you.