What Happens During a Miscarriage?

Miscarriage symptoms and treatments depend on the timing and cause of the loss.

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Many pregnant women wonder at some point in their pregnancy what happens during a miscarriage.

Exactly what happens during a miscarriage varies by the cause and type of miscarriage. However, if you experience bleeding at any point in your pregnancy, you should talk to your doctor right away.

What Happens During A First Trimester Miscarriage?

In most first trimester miscarriages, the pregnancy stops developing early on.

The woman's body then recognizes that the pregnancy is not viable and begins to shed the uterine lining, leading to mild cramping and vaginal bleeding. These are the most common signs of miscarriage.

However, a woman's body does not always immediately recognize that a pregnancy is not viable. Sometimes, weeks can pass before miscarriage symptoms appear. If an ultrasound takes place during this time period, the doctor will usually diagnose a missed miscarriage or a blighted ovum. In these cases, a woman might need medicine or surgery (a D&C, or dilation and curettage) to complete the miscarriage. 

What Happens During A Threatened Miscarriage?

Most of the time, the fetus's heart has stopped beating before bleeding or cramping appears. However, in some cases, the heartbeat may still be detectable and the cervix is closed, even though there is bleeding. This will most likely be diagnosed as a threatened miscarriage.

Usually, the bleeding stops in these cases and the pregnancy is still viable. Sometimes, however, a threatened miscarriage will progress to an actual miscarriage. There is nothing you or your doctor can do to prevent this, although you may be told to avoid sex, heavy exercise, and heavy lifting. These strategies are not proven to prevent miscarriage, but they may help you feel more comfortable.

What Happens During Second Trimester Pregnancy Loss?

Early second trimester miscarriages can happen the same way as first trimester miscarriages. In these cases, the baby's heart stops and the woman begins to have miscarriage symptoms. 

Late second trimester miscarriages might mean that the baby dies and the woman no longer feels any movement. After 20 weeks, this type of pregnancy loss is considered a stillbirth. The woman might require a surgical procedure called a D&E (dilation and evacuation) to complete the loss rather than waiting for the process to happen naturally. 

In the second trimester, miscarriage can also occur because of cervical insufficiency or preterm labor.

With preterm labor in the second trimester, doctors can sometimes stop labor with medical intervention—such as by prescribing certain drugs along with bed rest, if the signs are caught early enough.

A miscarriage because of cervical insufficiency might occur without any warning. In this type of miscarriage, the cervix slowly thins and the baby is born too prematurely to survive, even if the pregnancy was otherwise viable.

Doctors can treat cervical insufficiency with a cervical cerclage, but only if the condition is detected early. Because cervical insufficiency is not common, doctors do not routinely screen women who do not have pre-existing risk factors. These risk factors include a prior loss because of the condition or a known congenital uterine malformation.

Pregnancy loss in the second trimester can also occur with maternal infection or maternal heath conditions, like if a mom has a clotting disorder. 

A Word From Verywell

If you find yourself worrying about experiencing a miscarriage, speak with your doctor. It's common to feel some anxiety during pregnancy, but it should not overwhelm you. Counseling or a support group may be helpful. 

Sources:

American College of Obstetrics and Gynecology. (May 2015). Practice Bulletin: Early Pregnancy Loss.

American Pregnancy Association. (August 2016). Miscarriage

Michels TC, Tiu AY. Second trimester pregnancy loss. Am Fam Physician. 2007 Nov 1;76(9):1341-46.

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