Diagnosis of a Miscarriage Without Bleeding

How Pregnancy Loss May Be Diagnosed Even Before Symptoms Occur

Depressed woman with head in hands
Missed Miscarriage Symptoms. Tom Merton / Getty Images

If you felt like you were pregnant but no longer have any pregnancy symptoms, is it possible that you could have miscarried even if you haven't had any bleeding?

Bleeding and Other Symptoms and Signs of Miscarriage

The most common sign or symptom associated with miscarriage is bleeding, and the bleeding can be variable at the start, ranging from small amounts of brown blood to heavy bleeding. Bleeding occurs when products of conception pass from the uterus through the cervix and vagina.

Nevertheless, besides bleeding, there are other symptoms of miscarriage including:

  • Cramping or dull pain in the back or pelvis that may be constant or come and go
  • Passage of fetal tissue—looks like a white solid mass covered in blood
  • Very early loss of morning sickness (keep in mind that morning sickness typically goes away by the fifth month of pregnancy)

If you experience any of these signs or symptoms—even if bleeding is absent—please contact your physician right away.

Miscarriage Without Bleeding

It is possible to have a miscarriage with no bleeding or cramping. That being said, the typical symptoms (bleeding and cramping) will eventually follow most of the time. While it sounds unlikely, diagnosing a miscarriage before symptoms occur is becoming more common as medical practitioners run earlier routine ultrasounds and checks.

Missed Miscarriages

When a miscarriage is diagnosed without bleeding, a situation called "missed miscarriage" is sometimes described.

The reason why the miscarriage is referred to as "missed" is that the body has not yet recognized that a woman is no longer pregnant.

Bleeding from a miscarriage rarely begins the instant the fetus is no longer viable, but rather after the mother's hormone levels drop—a signal to the body that the pregnancy can no longer continue.

At this point, a woman's uterine lining will begin to shed and bleeding will begin (similar to a menstrual cycle). This can take a few days or weeks, which is why ultrasounds performed after early pregnancy bleeding will often show that the baby passed one to two weeks before the actual onset of bleeding.

But if an ultrasound is performed for some other reason, such as a routine check for a heartbeat, it is possible for the ultrasound to detect that the baby has miscarried before the mother has begun to have any miscarriage symptoms, and she may even still feel pregnant.

The Symptom Timeline and Medically Induced Miscarriage

In most cases, the miscarriage bleeding would start on its own within two weeks following the diagnosis. But given the uncertainty of the time range and the emotional aspects of carrying a nonviable pregnancy, many moms opt for a D&C or medically induced miscarriage once the diagnosis has been confirmed, preferring to get the physical aspect of the miscarriage over with as quickly as possible.

With that in mind, expectant management, meaning waiting for the miscarriage to occur naturally, is also a reasonable option.

For most people, there is no single method which is considered "best," and people are often told to choose the method they feel most comfortable with.

If you are facing this decision, here are some of the pros and cons to consider.

Advantages of Each Method

  • Watchful waiting: This is the least invasive approach and may feel more "natural" for some women. It also has a cost advantage over other methods.
  • Cytotec (misoprostol) medically induced a miscarriage: This approach is less invasive than surgery but more invasive than watchful waiting—a kind of "in between" approach. Most people are able to do this as an outpatient. While successful for most women, those who fail to complete miscarrying will need a D&C.
  • D&C surgical approach: With a D&C, the removal of the products of conception can be done at the time you choose, and you will be able to return to your life more quickly (usually.)

    Disadvantages of Each Method

    • Watchful waiting: With this approach, you have to wait to pass the fetal tissue, which can be emotionally and physically challenging—moderate to heavy bleeding and cramping may occur. In addition, people who choose watchful waiting may end up having an unplanned D&C.
    • Cytotec (misoprostol) medically induced a miscarriage: Cytotec has some mild side effects such as nausea, vomiting, and diarrhea. The medication doesn't work instantly, so it may take some time before the miscarriage is complete. Like watchful waiting, a woman may experience bleeding that is heavier than menses and moderate to severe cramping.
    • D&C surgical approach: This is the most invasive of the methods and can be done under general anesthesia (with the risks of anesthesia) in an operating room or sometimes in an office setting. Rarely, women may develop uterine adhesions (Asherman's syndrome), which could lead to problems with infertility. There is also a very small risk of damage to the cervix or uterine perforation. This is also the most costly of the methods.

    The big picture here is that when it comes to managing your miscarriage, a doctor will mostly consider your preference. The risks are quite comparable among the approaches—significant bleeding and/or infection may occur with all three (although this is rare). 

    A Word From Verywell

    A possible missed miscarriage is scary to any pregnant woman, and worry may be warranted because it does happen. However, the majority of pregnancies continue without these complications. Sadly, most of the time, if you have miscarried, there isn't anything anyone can do to affect this outcome, especially in the first trimester.

    If you are feeling anxious about your own pregnancy, talk with your personal doctor for further guidance. If you learn that you've had a miscarriage, it can be a challenging time as you cope with the physical treatments in addition to the emotions of loss.

    Reach out to family and friends. Some people find it very helpful to talk to others who have faced a similar situation, either among their friends or through one of the many support organizations designed to help people cope with pregnancy loss.

    Sources

    Black, K., deVries, B., Moses, F. et al. The Impact of Introducing Medical Management on Conservative and Surgical Management for Early Pregnancy Miscarriage. The Australian and New Zealand Journal of Obstetrics and Gynaecology. 2017. 57(1):93-98.

    Cunningham. Williams Obstetrics, 24e McGraw-Hill, 2014. Print.

    Segawa, T., Kuroda, T., Kato, K. et al. Cytogenetic Analysis of the Retained Products of Conception after Missed Abortion Following Blastocyst Transfer: A Retrospective, Large-Scale, Single-Centre Study. Reproductive Biomedicine Online. 2017. 34(2):203-210.

    The American Congress of Obstetrics and Gynecologists. (May 2015). Practice Bulletin: Early Pregnancy Loss

    Tulandi T, Al-Fozan HM. (January 2017). Spontaneous abortion: Risk factors, etiology, clinical manifestations, and diagnostic evaluation. In: UpToDate, Levine D, Barbieri RL (Eds), UpToDate, Waltham, MA. 

    Continue Reading