A missed miscarriage typically occurs during the first trimester. It is often diagnosed 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.
This article discusses what causes a silent miscarriage and how it is diagnosed and treated.
Missed Miscarriage Causes
Like all types of miscarriage, a missed miscarriage is when a fetus has died or 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.
Why some miscarriages announce themselves with signs and symptoms and others don’t isn’t well understood.
However, when a missed miscarriage does happen, its silent nature is related to the fact that it’s taking longer than normal for hormone levels to drop.
In contrast, miscarriages that cause signs and symptoms like bleeding and cramps involve hormone levels that plunge within hours, days, or weeks of fetal death.
Are There Really No Symptoms or Signs?
A miscarriage usually begins with pain similar to menstrual cramps and vaginal bleeding, but a missed miscarriage usually causes none of this.
Sometimes, a person might have cramping and/or brownish-pink or red vaginal discharge. But most often, there are no signs that anything is wrong. Lack of fetal movement wouldn’t alert someone, since most miscarriages happen early in pregnancy, before movements can be felt.
But even though a silent miscarriage has occurred, pregnancy hormones are still high. This means a pregnant 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.
Diagnosing a Silent Miscarriage
A missed miscarriage is often diagnosed during a prenatal care visit. An ultrasound may show the fetus is too small for gestation age or the heartbeat is undetectable. Sometimes, another scan is ordered a week to 10 days later to ensure there is no heartbeat.
A missed miscarriage might also be noted at around 20 weeks gestation when an anomaly scan (a mid-pregnancy scan performed between weeks 18 and 21 to examine the fetus for physical abnormalities) is performed.
A scan of a missed miscarriage will usually show the fetus or embryo (depending on the stage of development) inside the amniotic sac, but it will appear smaller than it should be and have no heartbeat.
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 embryonic demise.
How a Missed Miscarriage Is 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.
A person will want to discuss the following options with their doctor or nurse-midwife:
Allowing the miscarriage to occur on its own without medical interventionTaking medication to induce the physical miscarriageHaving a surgical procedure (such as a dilation and curettage) to remove the deceased fetus
Summary
A missed miscarriage happens when fetal death occurs, but the fetus 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.
A Word From Verywell
When you find out you have had a silent miscarriage, you may feel so overwhelmed that you do not feel prepared 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, your healthcare provider will discuss your options with you. Reach out to your loved ones for support, and if you feel like you need to talk to a mental health professional, let your doctor know you would like a recommendation or referral. Support groups may also be helpful.
