A missed miscarriage happens when the fetus stops developing within the uterus without apparent signs such as bleeding, lower abdominal cramping, or back pain. It's also known as a silent miscarriage or silent abortion.
A missed miscarriage typically occurs during the first trimester. It is often diagnosed when there is no fetal cardiac activity during a routine prenatal ultrasound. Treatment options include waiting for nature to take its course, medication to expel the remains, and, in some cases, surgery.
Missed miscarriage is emotionally difficult for many reasons. The loss of a pregnancy can be devastating under any circ*mstances. In a missed miscarriage, the lack of typical symptoms of pregnancy loss makes it a particular shock and even more challenging to understand that it is not the pregnant person's fault.
This article discusses what causes a silent miscarriage and how it is diagnosed and treated.
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What Causes a Missed Miscarriage?
Like all types of pregnancy loss, a missed miscarriage is when a fetus has ceased to develop in utero. This may occur because of a genetic problem in the fetus. Sometimes a structural problem with the uterus or cervix or a health problem can lead to miscarriage as well.
Some pregnancy losses announce themselves with signs and symptoms, and others don't. But the reason why some do not isn't well understood. It is believed that during a missed miscarriage, the body takes longer to stop producing pregnancy hormones. For this reason, there are no outward symptoms like bleeding and cramping.
In contrast, pregnancy loss that causes signs and symptoms like bleeding and cramps involves hormone levels that plunge within hours, days, or weeks of fetal loss.
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Are There Really No Symptoms or Signs?
A miscarriage usually begins with pain similar to menstrual cramps and vagin*l bleeding, but a missed miscarriage usually causes none of this.
Sometimes, a person might have cramping and brownish-pink or red vagin*l discharge. These symptoms are usually mild, and since they are also things that can occur during a normally-developing pregnancy, they might not tip a person off that something isn't right.
It's not known exactly how common silent miscarriages are, but one study estimated that missed miscarriages occur in around 3% of pregnancies.
But most often, there are no signs that anything is wrong. A lack of fetal movement wouldn't alert someone since most pregnancy loss happens early in pregnancy before movements can be felt.
But even though a silent miscarriage has occurred, pregnancy hormones are still high. This means a person may continue to experience pregnancy symptoms such as breast tenderness, nausea, and fatigue, though possibly to a lesser extent than before.
A pregnancy test may continue to show a positive result as well.
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How Is Missed Miscarriage Diagnosed?
A missed miscarriage is often diagnosed during a prenatal care visit. An ultrasound may show the fetus is too small for gestation age or that cardiac activity is undetectable. Sometimes, another scan is ordered a week to 10 days later to ensure no cardiac activity.
Fetal demise may also be noted at around 20 weeks gestation when an anatomy scan (a mid-pregnancy scan performed between weeks 18 and 21 to examine the fetus for physical abnormalities) is performed.
A scan will usually show the fetus or embryo (depending on the stage of development) inside the amniotic sac. Still, it will appear smaller than it should be and have no cardiac activity.
The scan could also show an empty amniotic sac or no sac. In this instance, the fetus stopped developing very early and has been reabsorbed by the body. Sometimes this is referred to as anembryonic pregnancy.
How Is Missed Miscarriage Treated?
The treatment for a missed miscarriage depends on a few factors, such as the stage of fetal development and the needs and preferences of the pregnant person.
Watchful Waiting
As hormone levels decrease during a first-trimester missed miscarriage, the contents of the uterus may begin to shed, leading to bleeding and cramping. Typical guidelines recommend waiting from seven to 14 days to see if the miscarriage progresses on its own.
If there are no signs of infection or medical problems, such as a known clotting disorder or unusual bleeding, one option is to wait to see if the miscarriage progresses.
However, this option can be very difficult psychologically for someone experiencing pregnancy loss. Many people do not want to bear this burden and choose to proceed with medication or surgery.
Medication
There are medications that patients can take to induce the body to shed the contents of the uterus during a missed miscarriage. The two medications typically used are mifepristone and misoprostol. Both are safe and effective options, and they can be used together to more significant effect.
Mifepristone causes the pregnancy tissue to detach from the uterine wall. Misoprostol causes the cervix to dilate and the uterus to contract, which allows the tissue to be expelled. The American Academy of Obstetricians and Gynecologists (ACOG) also recommends that patients receive pain management measures.
This option gives the patient more control over the location and timing. Patients can feel a greater sense of control, ensuring they can be at home and as comfortable as possible, allowing them to have support to help them through this difficult time.
Surgery
Surgical treatment offers immediate completion of miscarriage in cases of missed miscarriage with less follow-up required. The procedures typically used are or dilation and evacuation (D&E).
In both procedures, the cervix is dilated. A long, sharp curette is used to scrape the pregnancy tissue from the sides of the uterus. In D&E, aspiration is used to help remove the tissue from the uterus. Both procedures are done under anesthesia.
Is It Difficult To Get Pregnant After a Missed Miscarriage?
It used to be that medical professionals recommended people wait six months before trying to become pregnant after pregnancy loss. However, more recent findings show that people who become pregnant within three months of pregnancy loss have an increased chance of having a healthy pregnancy and birth.
How to Cope Emotionally After A Missed Miscarriage
When you find out you have had a silent miscarriage, you may feel overwhelmed and unprepared to participate in treatment decisions.It's OK if you need to take a few days to process what has happened before deciding what you will do next.
When you are ready, a healthcare provider will discuss your options. Reach out to your loved ones for support. If you need to talk to a mental health professional, let a healthcare provider know you would like a recommendation or referral. Support groups may also be helpful.
Summary
A missed miscarriage happens when the fetus stops developing but has not been physically miscarried yet. If a person has a missed miscarriage, they might not have any symptoms. The condition might only be discovered when they have an ultrasound at a prenatal visit.
When a missed miscarriage is diagnosed, a person might be asked if they want to wait to see if the fetus will physically miscarry naturally. If this does not occur, medications and medical procedures can be used to complete the miscarriage.
