Threatened Miscarriage

What is a threatened miscarriage?

A threatened miscarriage (threatened abortion) describes a pregnancy that could possibly end in miscarriage due to mild vaginal bleeding with or without abdominal pain or cramping. The bleeding tends to stay light and cramping remains mild, sometimes lasting several days or weeks. Threatened miscarriages occur in the first half (up to 20 weeks) of pregnancy, but most commonly in the first trimester (13 weeks) of pregnancy.

Many pregnant people experience vaginal bleeding or mild cramping during pregnancy. This doesn’t mean that there’s a problem with the pregnancy or that miscarriage will happen. In many cases, you’ll go on to have a healthy pregnancy. These symptoms mainly tell your provider that further monitoring may be necessary.

Contact your pregnancy care provider if you have vaginal bleeding, abdominal pain or cramping.

Can a fetus survive a threatened miscarriage?

Yes, many fetuses survive and the pregnancy continues. One study found that of the 25% of pregnant people that had some vaginal bleeding in the first 20 weeks of pregnancy, 60% of them continued with the pregnancy to term (37 weeks).

How common is a threatened miscarriage?

Threatened miscarriage may occur in about 15% to 20% of all pregnancies before 20 weeks.

What are the symptoms of a threatened miscarriage?

A threatened miscarriage typically includes one or both of the following:

• Vaginal bleeding (anything more than light spotting). The bleeding is mild and may include passing small clots or tissue-like material.
• Abdominal cramps. The pain is typically dull, not sharp or intense. However, it can progress to constant, severe pain.

If you think or know you’re pregnant and have any symptoms of threatened miscarriage, contact your pregnancy care provider right away. Other conditions can cause vaginal bleeding and pelvic pain, so it’s best to discuss your symptoms with a healthcare professional so they can figure out what’s going on.

What causes a threatened miscarriage?

There isn’t one cause of a threatened miscarriage. Some factors that play a role in a person experiencing a miscarriage include:

• Chromosomal problems with the fetus.
• Previously having a miscarriage.
• Alcohol or drug use or exposure to chemicals early in the pregnancy.
• Having obesity.
• Being older than 40 during pregnancy.
• Smoking cigarettes or vaping.
• Problems with the placenta.
• Trauma or injury.
• Vaginal or uterine Infections.

How long does a threatened miscarriage last?

A threatened miscarriage can last several days or several weeks. The exact timing and symptoms vary from person to person.

Do HCG levels drop with threatened miscarriage?

Sometimes. HCG (human chorionic gonadotropin) is known as the “pregnancy hormone.” HCG increases steadily until about 11 weeks of pregnancy (sometimes doubling every few days). In general, if HCG levels decline over several days, prior to 11 weeks, a miscarriage is likely. But, in the case of a threatened miscarriage, a person’s HCG levels may remain steady. If your HCG levels are low, your provider will recheck your levels every two to three days.

It’s important to note that in healthy pregnancies, HCG levels drop after about 11 weeks. Please consult your healthcare provider to interpret your HCG levels.

How do healthcare providers detect a threatened miscarriage?

Your pregnancy care provider will ask your about your symptoms and go over your medical history. They may also:

• Perform a vaginal or pelvic ultrasound to check the fetus’s heartbeat.
• Do a pelvic exam to check if your cervix is closed.
• Order hormone blood tests to check levels of HCG and progesterone.
• Order additional bloodwork to rule out infection or other conditions.
• Order bloodwork to check your blood type (Rh factor). You may require an immune globulin injection (RhoGAM®) if you have a negative blood type. About 15% of women and people assigned female at birth (AFAB) in the United States have a negative blood type.

With a threatened miscarriage, your pregnancy care provider will see that your cervix is closed. A prenatal ultrasound may also show a fetal heartbeat.

How do healthcare providers treat a threatened miscarriage?

In many cases, watchful waiting is the only treatment for a threatened miscarriage. Your pregnancy care provider may schedule follow-up tests to check hormone levels. There’s nothing your provider can do to stop a miscarriage from occurring.

Some pregnancy care providers prescribe progesterone, a hormone that supports a pregnancy. Low levels of progesterone may be a sign of a threatened miscarriage. You can take progesterone through injections, suppositories or tablets. The studies on its effectiveness are mixed, however most studies show it increases live birth rates in people who experience vaginal bleeding early in pregnancy.

Bed rest was once recommended, but there’s no evidence that bed rest helps stop a miscarriage. Your provider will still recommend taking it easy until the threat of a miscarriage passes. Some things you can do include:

• Pelvic rest: Avoid sex or placing anything inside your vagina until your symptoms are gone for at least one week.
• Rest: Taking care of yourself by getting enough sleep and not engaging in strenuous activities may be helpful.
• Distractions: Visit friends, read books or watch TV or movies to keep yourself busy as you wait.

Can you prevent a threatened miscarriage?

There’s rarely anything you or your provider can do to prevent a threatening miscarriage. Follow the advice of your pregnancy care provider if they believe your pregnancy is at risk for a miscarriage. Attending all of your prenatal appointments and listening to your pregnancy care provider are things you can control.

Other things you can do to support a healthy pregnancy include:

• Avoiding drinking alcohol, smoking cigarettes or using recreational drugs.
• Avoiding exposure to chemicals, toxins or other substances known to harm a fetus.
• Taking a prenatal vitamin containing folic acid.
• Eating a healthy diet full of vegetables and fruits.
• Exercising around 20 to 30 minutes per day.
• Getting treatment for or managing any diseases, infections or chronic health conditions.

What should you do if you have a threatened miscarriage?

If your provider tells you that you have a threatened miscarriage, ask them what you can do while you wait for the outcome. While there aren’t any treatments to stop a miscarriage, they may have suggestions on what you can do at home to care for yourself. Continuing with your prenatal care is important, so be sure to attend any follow-up appointments or tests.

Should I worry about threatened miscarriage?

It’s normal to worry about a threatened miscarriage. While waiting for tests or your next appointment, you may feel anxious or sad. While you wait for the outcome, try to take extra care of yourself. Surround yourself with supportive people and try to relax as best you can. Remember, many people go on to deliver healthy babies despite a threatening miscarriage.

However, if a miscarriage happens, please know it’s not your fault. Allow yourself time to grieve and recover from the loss. A pregnancy loss is still a loss no matter when it occurs.

When should I see my healthcare provider?

Contact your pregnancy care provider if you experience vaginal bleeding or cramping during pregnancy. They can examine you and perform tests to check on the health of the fetus.

A note from Cleveland Clinic

A threatened miscarriage is a common complication in early pregnancy that results in vaginal bleeding and, possibly, pelvic pain. In a lot of cases, the pregnancy continues to term and you deliver a healthy baby. However, sometimes the outcome isn’t positive and ends in miscarriage. Try to relax and find comfort from family and friends during this time of watchful waiting. Remember, a miscarriage is beyond your control and nothing you did caused it.