Overview
The physical and emotional experience of a miscarriage can vary significantly based on the cause and timing of the loss and other individual factors. Those that occur in very early pregnancy can be quite different from those that happen in the second or third trimester. In some cases, miscarriage can happen almost invisibly, as with so-called missed or silent miscarriages that have no outward symptoms. Below, we take a look at what typically happens in first-trimester, threatened, and second-trimester miscarriages. Knowing more about causes, signs to look for, and what to expect can help you cope if pregnancy loss happens to you.
First-Trimester Miscarriage
Miscarriages happen most often in the first trimester, with many happening before 10 weeks gestation. For the most part, nothing can be done to prevent or stop these pregnancy losses.
Causes
In most first-trimester miscarriages, the embryo or fetus stops developing early on, often due to chromosomal or placental problems. In these cases, the woman’s body will recognize that the pregnancy is no longer viable and begin to shed the uterine lining. This is the process that causes the telltale signs of miscarriage, namely cramping and vaginal bleeding.
Symptoms
In some cases, the bleeding may be light, similar to a regular period. Other women may experience more subtle signs, such as the sudden loss of pregnancy symptoms like morning sickness or breast tenderness. In other instances, weeks may pass before any signs or symptoms appear.
Confirmation and Treatment
If pregnancy loss occurs during the first trimester, an ultrasound and/or blood tests may be used to confirm the diagnosis. Depending on the timing or cause, the woman may choose to complete the miscarriage naturally or seek assistance to speed up the process in the form of medications or a surgical procedure called dilation and curettage (D&C).
Threatened Miscarriage
In most miscarriages, the baby’s heart will have stopped beating before the outward symptoms of miscarriage appear. However, in some cases, vaginal bleeding will occur when the heartbeat is still detectable and the cervix remains closed. This is called a threatened miscarriage. In many instances, the bleeding will stop and the pregnancy will remain viable. In others, the threatened miscarriage will end in a loss of the pregnancy. There is really no way to predict the outcome. While some doctors will recommend rest and the avoidance of sex, exercise, tampons, and heavy lifting, there is little evidence that these interventions help to preserve the pregnancy.
Second-Trimester Miscarriage
Early second-trimester miscarriages are treated in much the same way as those in the first trimester. However, as the fetus will be further along in its development, the loss will typically be confirmed by the lack of a fetal heartbeat. This is often done via ultrasound.
Causes
Two common causes of miscarriage in the second term include cervical insufficiency (the premature dilation of the cervix) or preterm labor (also known as premature birth). With cervical insufficiency (also known as an incompetent cervix), the baby may be born too early to survive. Doctors can sometimes delay delivery with a cervical cerclage (a stitch used to hold the cervix closed). With preterm labor, doctors can sometimes halt the process with anti-contraction medications and bed rest if the condition is detected early. There are multiple other reasons for second-trimester miscarriage, including:
Congenital conditions (such as uterine structural malformation) Drug use (such as cocaine) Genetic abnormalities in the fetus Maternal infection (such as bacterial vaginosis or an amniotic infection) Maternal medical issues (including diabetes, pre-eclampsia, lupus, or thyroid issues) Physical issues with the uterus (such as fibroids) Placental problems (such as placental abruption or placenta previa) Trauma
Sometimes, the cause of pregnancy loss may be uncertain.
Symptoms
Symptoms of miscarriage in the second trimester tend to be similar to those in the first trimester—bleeding, cramping, and loss of pregnancy symptoms. These signs may be experienced to a greater magnitude than in the first trimester or may be completely absent. Some mothers do not notice any signs of pregnancy loss at all until their next prenatal visit, when their practitioner fails to detect a fetal heartbeat during a routine ultrasound check. Other women notice the cessation of regular fetal movements.
After 20 Weeks
Pregnancy loss after 20 weeks is considered a stillbirth. In this event, the baby will have died in utero, for any of the above reasons, and the mother will no longer feel any movement. More often than not, the woman will require a D&C procedure to remove the fetal tissue rather than waiting for the process to happen naturally.
A Word From Verywell
Miscarriage can be an emotionally wrenching experience for many women. It can help to know that in most cases there was no chance of bringing the baby to term, and miscarriage is not anyone’s fault. If this happens to you, be sure to tend to your emotional wellbeing as well as the physical recovery from pregnancy loss.
