A missed miscarriage is a type of pregnancy loss where the embryo or fetus has stopped developing, but the body has not yet expelled the pregnancy tissue. This can be distressing because there are often no immediate outward signs. Unlike other miscarriages with clear symptoms, a missed miscarriage can go unnoticed until a medical examination.
Understanding Missed Miscarriage
A missed miscarriage means the body does not immediately recognize the pregnancy loss, so typical symptoms like bleeding or cramping may not occur. The embryo or fetus ceases development, but the placenta and gestational sac might continue to grow. Individuals may still experience common pregnancy symptoms like breast tenderness, fatigue, or nausea due to continued hormone production. A pregnancy test might also still show a positive result.
Recognizing Signs and Diagnosis
Subtle or absent physical signs characterize a missed miscarriage. Individuals might notice a plateau or decrease in pregnancy symptoms, such as morning sickness subsiding or breast tenderness diminishing. However, sometimes these symptoms continue, making the diagnosis even more unexpected.
Diagnosis is made through medical imaging, specifically an ultrasound, which reveals the absence of a fetal heartbeat or a fetus smaller than expected for gestational age. Blood tests, particularly those measuring human chorionic gonadotropin (hCG) levels, also confirm the diagnosis, often showing levels that are not rising appropriately or are declining. A follow-up ultrasound or repeated hCG tests may be advised to confirm the diagnosis.
Management Options
Once a missed miscarriage is diagnosed, healthcare providers discuss several management options, with the choice often depending on individual preference and medical circumstances. One approach is expectant management, which involves waiting for the body to naturally expel the pregnancy tissue. This can take days or even weeks, during which light spotting or bleeding may precede heavier bleeding and cramping.
Another option is medical management, which uses medication to induce the miscarriage. Misoprostol is commonly prescribed, often taken orally or vaginally, to help the uterus contract and expel the tissue. This method starts cramping and bleeding within a few hours, though it can take up to 48 hours for tissue to pass. A combination of mifepristone and misoprostol is more effective than misoprostol alone for completing a missed miscarriage.
Surgical management, such as Dilation and Curettage (D&C), is another choice. This procedure involves opening the cervix and removing the pregnancy tissue from the uterus. Surgical management is recommended for individuals who prefer a quicker resolution, or if expectant or medical management is not successful. Each option carries its own considerations regarding recovery time and emotional impact, making consultation with a healthcare provider important for an informed decision.
Potential Causes
The exact cause of a missed miscarriage often remains unknown. A missed miscarriage is rarely due to anything the individual did or did not do. The most common underlying reason is a chromosomal abnormality in the developing embryo. Approximately 50% to 70% of early miscarriages are attributed to such genetic conditions.
Less common factors include structural problems with the uterus or cervix, hormonal imbalances, or medical conditions like autoimmune disorders or uncontrolled diabetes. Infections can also increase the risk. Often no clear explanation is found, and stress, exercise, or travel are not causes of miscarriage.
Emotional Recovery and Future Planning
Experiencing a missed miscarriage can have a significant emotional impact, leading to feelings of grief, shock, sadness, anger, guilt, and confusion. These emotions are normal responses to the loss. Allowing oneself to grieve is an important part of the healing process. Seeking support from partners, friends, and family can provide comfort during this difficult time.
Many individuals find solace in support groups for pregnancy loss, where they can connect with others who have similar experiences. Professional counseling can also offer coping strategies and emotional support. Looking ahead, one missed miscarriage does not affect the ability to have a healthy pregnancy in the future. Healthcare providers recommend waiting at least one menstrual cycle before attempting to conceive again.