A miscarriage is medically defined as the spontaneous loss of a pregnancy before the 20th week of gestation. This is a common experience, and having clear, factual information about the physical signs can provide a sense of preparation during a difficult time. Understanding what materials may be expelled is a valid need for anyone experiencing this loss. The physical process involves the body passing the pregnancy tissue, which includes the developing embryo or fetus, the placenta, and the surrounding membranes.
Distinguishing Miscarriage Bleeding and Clots
The process of miscarriage begins with the body shedding the uterine lining and the pregnancy material, which results in vaginal bleeding and the passage of blood clots. This bleeding often starts as light spotting but can quickly progress to a flow significantly heavier than a typical menstrual period. Miscarriage bleeding is frequently described as bright red, though it can also appear dark or brown, sometimes with a grainy consistency.
The intensity of the flow may be heavy enough to soak through more than one sanitary pad per hour for a few hours, and this heavy flow may be accompanied by strong cramping. The blood clots passed can be notably larger than those seen during menstruation, sometimes reaching the size of a quarter or even a lemon. While menstrual clots are usually jelly-like and dark red, miscarriage involves the expulsion of material that is structurally different from simple blood clots. The heavy bleeding and cramping generally peak as the main pregnancy material is passed, and then the flow typically lessens to a lighter, period-like state over the following days.
Identifying Products of Conception
The term “products of conception” (POC) refers to all the tissue derived from the fertilized egg, including the embryo or fetus, the placenta, and the amniotic sac. The appearance of this tissue depends heavily on the gestational age at the time of the loss.
In a very early miscarriage, such as between four and six weeks, the expelled material may be difficult to distinguish from a heavy blood clot. This early tissue often appears as a thick, grayish or pinkish-gray material that may have a fibrous or liver-like texture. It is structurally more cohesive than a simple blood clot, which will easily tear apart. The embryo itself is microscopic at this stage and is usually contained within this mixture of blood and tissue.
As the pregnancy progresses to the later first trimester, around eight to twelve weeks, the products of conception become more discernible. The gestational sac, which is the fluid-filled membrane that surrounds the embryo, may be visible. This sac can look like a small, white or translucent bubble or sphere mixed in with blood and blood clots.
The developing embryo or fetus may also be visible within the sac, appearing as a small form that is distinct from the surrounding tissue. The tissue from the placenta and surrounding membranes, called chorionic villi, is often identifiable as grayish or whitish material. The passing of this tissue, regardless of gestational age, often marks the most intense part of the cramping and bleeding process.
Post-Expulsion Medical Guidance
After the primary tissue has been expelled, contacting a healthcare provider is an important next step to confirm that the miscarriage is complete. A medical professional will often use an ultrasound to check for any retained products of conception (RPOC) remaining in the uterus, as this can lead to infection or continued heavy bleeding. If a complete miscarriage is confirmed, the bleeding and cramping should gradually subside over the next one to two weeks.
If the miscarriage happened at home, a healthcare provider might request that any tissue passed be collected for pathological or genetic testing. The preferred method for collection is to place the most solid-looking tissue into a clean, sealed container or plastic bag. This sample should be stored in the refrigerator, not the freezer, until it can be transported to the clinic or laboratory for analysis.
It is important to monitor for signs that require immediate medical attention, even after the tissue has passed. Seek emergency care if there is excessive bleeding, defined as soaking through two full-sized sanitary pads in one hour for two consecutive hours or more. Other warning signs include the development of a fever, severe abdominal pain that is not relieved by over-the-counter pain medication, or vaginal discharge that has an unpleasant odor. These may indicate an infection or an incomplete miscarriage.