Signs of a Miscarriage

Updated: January 2025

Miscarriage is one of the most common pregnancy complications, and yet it’s hardly discussed. It happens in 1 in 5 pregnancies, and up to 80% of miscarriages occur in the first trimester.

Miscarriage is truly no one’s fault, in the first trimester it commonly occurs because of chromosomal abnormalities.

Miscarriage Risk Factors

Certain things can increase risk when it comes this miscarriage. This includes:

• Chromosomal abnormalities

• Maternal and paternal age

• Environmental exposure

• Certain hormonal issues

• Immune factors

• Coagulation disorders

• Nutritional deficiencies

Signs and Symptoms

The most common signs associated with miscarriage is bleeding and cramping. While these alone can happen in a viable pregnancy, when happening together it does lead to a higher likelihood of miscarriage.

Diminishing signs of pregnancy may also be seen such as lessening nausea and vomiting and breast tenderness.

Diagnosis

Unfortunately, you can't self-diagnose a miscarriage. You may see the signs and symptoms that are occurring, but ultimately you should present to your doctor or the emergency room where some blood testing like beta-hCG should be done, likely followed by a vaginal exam with a speculum, as well as an ultrasound to determine fetal cardiac activity as well as how big the fetus is (crown-rump length).

Types of Miscarriage & Management

Threatened Miscarriage

This occurs when someone notices vaginal bleeding within the first 20 weeks of pregnancy. They may also experience backache, abdominal aching or cramping. The cervix will appear closed upon vaginal inspection. The fetal heartbeat may be found via the ultrasound. Essentially, we treat this as a viable pregnancy, until we're concerned that there's no ‘heartbeat’.

Medical Treatment: Watch and wait, bed rest, possibly supplementing with progesterone and administering uterine muscle relaxants. 

Naturopathic Treatment: Watch and wait, assessing for stress, dehydration and malnutrition. UTIs should also be ruled out. Acupuncture may help to harmonize the different pathways in the body. In TCM terms, this is considered a kidney yang deficiency, and the uterus must be kept warm (think of warm foods, heat over the abdomen, stimulating the appropriate acupuncture points, etc.).

Inevitable Miscarriage

This happens when bleeding and cramping are present - which may range between minimal to severe. The cervix appears dilated, with passage of blood or tissue. There may be fetal cardiac activity on ultrasounf.

Medical Treatment: Pain medication if required, ultrasound for diagnosis, treatment for substantial blood loss, blood work, dilation and evacuation to empty the uterus. 

Naturopathic Treatment: Emotional support, addressing blood loss, physiological and psychological stress. Supporting the menstrual cycle. 

Incomplete Miscarriage

Incomplete miscarriage involves bleeding or cramping, where the cervix may be open or closed. Ultrasound will show no fetal cardiac activity indicating that the baby has passed on, or is part of the tissue that has yet to pass. 

Medical Treatment: Pain medication if required, ultrasound for diagnosis, treatment for substantial blood loss, blood work, management may be a watch and wait approach, involve medication or surgery.

Complete Miscarriage

Complete miscarriage occurs with cramping and bleeding. The cervix may be closed because all tissue has passed, but some ongoing spotting or bleeding may still occur for a few days. Cramping and abdominal pain may subside shortly after. Ultrasound will show no fetal cardiac activity.

Missed Miscarriage

Unfortunately the baby has passed, but is still present in the uterus with no signs of miscarriage. This may continue for a few weeks before a miscarriage occurs, or it may be found at a routine checkup. Because it may lead to a serious maternal infection, medical care must be obtained. 

Medical Treatment: Confirmation by ultrasound, and evacuation of the products of conception. 

Naturopathic Treatment: Emotional support, regulation of the menstrual cycle. 

Recurrent Miscarriage

'Recurrent' is diagnosed if there is a history of 2 or more pregnancy losses. Once this particular diagnosis is reached, it's advised that both partners undergo genetic testing to determine a possible cause of miscarriage. Moreover, the couple may need undergoing care if a chronic problem presents.

Typically hormonal causes are the most prevalent, and may involve the ovary, placenta or thyroid. Diseases also involved with recurrent miscarriage include: hypothyroidism, hyperthyroidism, PCOS, type 2 diabetes, gynecological disease (ie. endometriosis).

Medical Treatment: Determine a cause, chromosomal evaluation of both parents. 

Naturopathic Treatment: Determine a why recurrent miscarriage is happening, prevent future miscarriages, and possibly supplement with a botanical like Vitex agnus-castus (Chaste Tree) if there is an issue with HPA axis and progesterone. In TCM terms kidney yin deficiency is the most common cause of recurrent miscarriages - this means that the uterine environment is hot and dry, the endometrial lining may not be thick enough to accept an embryo. 

Next Steps

Experiencing a miscarriage is devastating. When you and your partner feel emotionally ready to try to conceive again, it is recommended to start after the first period after the miscarriage.

For couples experiencing recurrent miscarriages - you may want to consult with a Naturopathic Doctor to get to the root cause of why they keep occurring, and try to implement therapies to make fundamental changes in the hopes that another miscarriage doesn’t occur again.

Supportive Resources

Sunnybrook Resources for Grieving Parents - They have compiled a huge database of web resources and chat rooms. This site is definitely worth a visit.