How common are missed miscarriages in the first trimester

Missed miscarriages don't come with obvious symptoms, which can make them all the more shocking when they're discovered. Here's what you need to know about how this type of pregnancy loss differs from most other miscarriages, how missed miscarriages are diagnosed, and what to expect as you recover. 

What is a missed miscarriage?

A missed miscarriage or silent miscarriage occurs when a fetus or embryo has died but no bleeding or loss of fetal tissue has yet taken place. Like other types of miscarriages, missed miscarriages occur unexpectedly before 20 weeks of pregnancy. 

Missed miscarriages are usually discovered at routine prenatal appointments when no signs of fetal cardiac activity can be found, but a woman hasn't experienced any of the typical miscarriage symptoms.   

While an estimated 20 percent or more pregnancies end in miscarriage, missed miscarriages are relatively uncommon. Specific numbers are hard to come by, but one study estimates that missed miscarriages affect less than 3 percent of pregnancies. 

What causes a missed miscarriage?

Missed miscarriages happen for the same reasons as miscarriages that cause symptoms: Most often, the fetus isn't developing as it should be (about 50 percent of all miscarriages are associated with an extra or missing chromosome in the fetus). 

Miscarriages are never a woman's fault. It's impossible to predict whether someone will have a miscarriage, and there's no way a woman can prevent a miscarriage from happening. 

What are the signs of a missed miscarriage?

By definition, a missed miscarriage is one that occurs without common miscarriage symptoms such as bleeding, passing tissue or cramping. Many women who have had a missed miscarriage don't know it until they go in for a routine prenatal appointment, when an ultrasound or Doppler reading shows no fetal cardiac activity.

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In some cases, a woman might notice that the pregnancy symptoms she was experiencing have suddenly stopped. Occasionally, a missed miscarriage may also cause a woman to have some brownish discharge.   

How is a missed miscarriage diagnosed?

Missed miscarriages are usually detected during a regular prenatal checkup. If cardiac activity isn't seen or heard during an ultrasound or while checking with a Doppler monitor, a health care provider may suspect a missed miscarriage. Likewise, the provider may also suspect a missed miscarriage if the ultrasound reveals an empty gestational sac.

Depending on how far along the pregnancy is, additional tests might be done to confirm the pregnancy loss. The doctor might perform an ultrasound if one wasn't already conducted, as well as check a woman's cervix to see if it has dilated or thinned. A blood test might also be ordered to check a woman's hCG levels, blood count and Rh factor. If the mother's Rh factor is Rh-negative, she may receive a RhoGAM shot to prevent serious problems in a later pregnancy. 

How is a missed miscarriage treated?

Because missed miscarriages don't involve bleeding or the loss of fetal tissue, the uterus needs to be emptied in order for a woman to recover, resume her menstrual cycle, and try to get pregnant again, if and when she decides she's ready. That can happen in one of three ways:

• Expectant management. Some women opt to wait for the pregnancy to expel itself naturally. This can take anywhere from a few days to a few weeks, during which time bleeding and cramping will occur. If any fetal tissue remains in the uterus after the pregnancy passes, surgery or medicine may be needed to remove it. Otherwise, the lingering tissue could cause an infection. 

• Medication. Medications including mifepristone combined with misoprostol can stimulate the uterus to expel the pregnancy. Usually, fetal blood and tissue are passed within 24 to 48 hours of taking the drugs (which may be taken orally or as a vaginal suppository). The drugs can cause bleeding and cramping as well as nausea or diarrhea.

• Surgery. Dilation and curettage, or D&C, is a minor surgical procedure that can be performed to remove fetal and placental tissue after a miscarriage. It can cause mild side effects like discomfort and light bleeding, and comes with a slight risk of infection. However, it can help complete the miscarriage process sooner.  

Deciding which course to take is a personal decision that should be made with your doctor. Ultimately, the right choice is the one that you feel most comfortable with. However, many women find that taking medication or undergoing a D&C is somewhat easier to handle emotionally. Waiting for the pregnancy to expel naturally takes longer, which can prolong the process of coming to terms with your loss. A D&C has the benefit, too, of making it easier to evaluate the cause of the miscarriage. 

How long does it take to recover from a silent miscarriage?

Once the pregnancy has fully passed, your body will recover from a miscarriage within a matter of weeks. But there's no one-size-fits-all timeline for dealing with the emotions of a pregnancy loss, and no right or wrong way to go about making sense of and accepting your loss. 

Physical recovery

Your physical recovery will depend on how the missed miscarriage was treated. 

• For expectant management: It's normal to experience period-like bleeding and cramping for a few days, followed by spotting that can persist for up to four weeks. 

• For medication or surgery: Mild cramping and bleeding for a few days are the norm. You may also have nausea or diarrhea.

In all three cases, you can expect to feel like yourself again physically within a few days, even with continued spotting. But you should avoid having sex or putting anything in your vagina (including tampons) for a full two weeks to reduce the risk for infection. Your period should return within four to six weeks. 

Pay attention, too, for signs that your body isn't healing properly. While infections after a miscarriage or D&C are rare, they can become serious if left untreated. Call your provider if you experience symptoms including heavy bleeding (soaking through more than two pads per hour for more than two hours, fever, chills or severe pain. 

Your emotions after a missed miscarriage

Recovering from a miscarriage emotionally is never easy, and the sense of shock that comes from a loss without symptoms can be even harder to process. No matter how early on in your pregnancy your miscarriage happened, you're allowed to grieve for your baby. Take the time that you need to rest, take care of yourself and process your feelings in the way that works best for you. 

Talking with your partner if you have one, a family member or friend who has miscarried, or even members of a support group can help you make sense of what happened and find a way to move forward. But if there are times when you'd rather just be alone with your thoughts, that's okay too.

You won't forget your lost pregnancy, but with time, you should gradually start to feel more like yourself. If that's not the case and you find yourself feeling isolated, withdrawn, anxious or unable to cope with everyday life, talk with a mental health professional. Counseling can give you the tools you need to move forward.

Getting pregnant after a missed miscarriage

The decision of when to try to get pregnant again is a personal one. You'll want to get the green light from your doctor first, but most practitioners agree that it's safe to try to conceive after a miscarriage after you've had at least one normal period. It's okay to wait longer too though, if you don't feel ready quite so soon. There's no rush.

When you do start trying, you might worry about your ability to get pregnant again, and once you do get pregnant, whether you'll experience another loss. While it's normal to have fears, keep in mind that most women who have miscarried go on to have healthy pregnancies and babies. 

Missed miscarriages can be shocking and devastating, and you'll never forget the pregnancy you lost. But the experience won't define you forever. Give yourself the time and space that you need, and eventually, you'll find room in your heart to move forward.

From the What to Expect editorial team and Heidi Murkoff, author of What to Expect When You're Expecting. What to Expect follows strict reporting guidelines and uses only credible sources, such as peer-reviewed studies, academic research institutions and highly respected health organizations. Learn how we keep our content accurate and up-to-date by reading our medical review and editorial policy.

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