Miscarriage: symptoms, diagnosis and when to seek urgent care

The signs

Bleeding, which may be light spotting or heavy with clots; cramping, often period-like and sometimes stronger; and the passing of tissue. Back pain is common.

Bleeding in early pregnancy does not always mean miscarriage — around one woman in four bleeds and goes on to a normal pregnancy. But all bleeding in pregnancy needs same-day assessment, because the causes that are serious cannot be told apart at home.

Some miscarriages have no symptoms at all and are found at a scan — a missed miscarriage, where the pregnancy has stopped developing but nothing has happened yet. That is one of the cruellest versions, because there was no warning.

How it is diagnosed

An ultrasound, usually transvaginal in early weeks, looking for the pregnancy's location, the sac, and cardiac activity where the dates should allow it.

Blood tests: hCG measured twice, 48 hours apart — in a healthy early pregnancy it rises substantially; in a failing one it plateaus or falls. Your blood group is also checked, because Rh-negative women need an anti-D injection.

Sometimes a repeat scan in one to two weeks is needed before anything can be said, particularly if the dates are uncertain. That wait is agonising and it is the responsible way to avoid a wrong conclusion.

Terms you may hear: threatened miscarriage (bleeding, pregnancy still viable), inevitable, incomplete (some tissue remains), complete, and missed.

What happens next

Three routes, depending on the situation and your preference. Expectant management: waiting for it to complete naturally, which can take days to weeks. Medical: tablets to help the uterus empty. Surgical: a short procedure under anaesthesia, sometimes called a D&C or MVA.

All three are safe and legitimate. Ask what is being recommended and why, what the recovery looks like, and what happens if the first approach does not complete.

Afterwards: bleeding for one to two weeks, a follow-up to confirm the uterus is empty, anti-D if you are Rh-negative, and periods usually returning within four to six weeks.

Ask about testing the tissue if this is a second or third loss, and about a follow-up appointment to discuss causes — that conversation is easier to have arranged now than to chase later.

When to see a doctor

Go to hospital immediately for: bleeding that soaks a pad an hour or more, severe or one-sided abdominal pain, dizziness or fainting, shoulder-tip pain, fever with chills, or foul-smelling discharge. A positive pregnancy test with one-sided pain and bleeding needs assessment the same hour — an ectopic pregnancy is life-threatening. Call 108 if you cannot travel quickly.

Also same-day: any bleeding in pregnancy at all, cramping with bleeding, or the passing of tissue. And after a miscarriage: heavy bleeding, fever, foul-smelling discharge or severe pain, which can indicate infection or retained tissue.

Grief after a pregnancy loss is real grief, at any number of weeks. If you are struggling — persistent low mood, hopelessness, panic, an inability to function, or any thought of harming yourself — that deserves help rather than endurance. Tele-MANAS on 14416 is free, confidential and answers round the clock in Indian languages.

This article is general information, not medical advice, and is no substitute for personal medical advice. For any decision about your or your child's health, please consult your doctor.

Frequently asked questions

Q: Did I cause it? — Almost certainly not. Most early miscarriages are caused by a chromosomal error at conception. Lifting, working, travelling, sex, stress, an argument and eating something are not causes, whatever anyone in the family says.

Q: Will I need a D&C? — Not always. Many miscarriages complete without any procedure, and medical management is an alternative. It depends on the type, the bleeding and your own preference.

Q: How long until my period returns? — Usually four to six weeks. If it has not returned in eight, or if bleeding continues, get checked.

Q: Should we have tests? — Investigation is usually offered after two or three losses, and earlier if there is a specific reason. Ask; it is a fair question at the follow-up.