What Are the First Signs of a Missed (Silent) Miscarriage?

Silent miscarriage is a rare phenomenon that causes emotional and physical distress in parents, in particular mothers. As its name suggests, this type of pregnancy loss happens without any obvious symptoms and can put the mother’s life in danger. Early treatment of missed abortion prevents severe bleeding, abdominal pain, and infection of the reproductive system. Therefore, knowing more about this problem and its complications is important. In this article, we look carefully at the most important signs of missed miscarriage, its causes, treatments, and the life after it. 

What Is Missed Miscarriage?

Missed miscarriage, also called silent miscarriage and missed abortion, is a disastrous event that happens in nearly %1 to %5 of all pregnancies. It happens when the fetus doesn’t grow normally (anembryonic pregnancy) or when it perishes in the uterus. Women experiencing silent miscarriage do not have any obvious symptoms as the placenta and embryonic tissue are still in their uterus, and their pregnancy hormones are still high. In other words, the pregnant mother doesn’t have severe bleeding, cramps, or even tissue discharge for some time after the death of the baby.

Missed abortion usually happens before week 20th of pregnancy, and the dead fetus usually doesn’t come out of the womb thoroughly. Therefore, it is important to get frequent checkups during the first trimester of pregnancy, especially if you have a history of miscarriage or stillbirth.  

Missed Miscarriage Symptoms

As mentioned earlier, a missed abortion usually has no distinct symptom, and the pregnant mother may not notice it for several days or weeks. Of course, the mothers can sometimes guess a missed miscarriage by observing the following symptoms. 

• Spotting or minor vaginal bleeding
• Brown vaginal discharges
• Cramps in the lower abdomen
• Reduction or loss of pregnancy symptoms such as nausea, food cravings, and breast tenderness
• Heavy, pinkish vaginal discharge
• Mild to severe back pain

The most common symptom of a normal miscarriage is bleeding, which starts exactly at the time of fetal loss. However, in missed abortion, vaginal bleeding occurs days after the fetal death. Therefore, the pregnant mother loses her child without noticing it. 

What Causes Missed Abortion?

In most cases, the cause of missed abortion is not clear, just like other unwanted abortions. About 50% of miscarriages that occur in the first trimester of pregnancy are due to the abnormal shape and number of chromosomes in the embryo. It should be mentioned that being stressed, having sex, exercising, or travelling does not cause silent miscarriage.

Problems such as cervical ulcers (caused by cervical cancer and STDs), uterine contraction, endocrine disorders, hormonal imbalance, or autoimmune disorders can increase the risk of miscarriage. Also, being hit in the abdomen or pelvis and other factors such as infection, diabetes, and thyroid diseases may lead to missed abortion. Therefore, treating these health issues as soon as their symptoms have emerged is important.

Read more: What Are the Leading Causes of Female Infertility?

Missed Miscarriage Diagnosis 

In the first trimester of pregnancy, the gynaecologist examines you repeatedly to ensure your baby is alive and healthy. If you have a history of miscarriage, a fertility issue, or a chromosomal disorder, you are more prone to missed miscarriage and should take the following tests frequently.

Ultrasound test

Ultrasounds often detect missed miscarriage before the 20th week of pregnancy. Usually, when the specialist cannot hear the heartbeat of the fetus, he/she notices the loss of the fetus. Of course, sometimes the fetal heartbeat is weak, and the doctor orders another ultrasound in about a week.

Hormone test

In the first 8 weeks of pregnancy, your doctor measures your blood's human chorionic gonadotropin (hCG) level for several days. The level of this hormone doubles every 48 to 72 hours during the first weeks of a natural pregnancy. Therefore, a low amount of hCG hormone shows that the fetus has perished and the pregnancy has ended. Also, if the hCG is not increasing regularly, the doctor orders another blood test and ultrasound to detect its cause.

ABO typing 

If the baby is Rh-positive, the mother’s Rh-negative blood type can increase the risk of missed miscarriage or stillbirth. So, your doctor might order ABO typing to detect your blood type. In case of being Rh-negative, the doctor prescribes Rh immunoglobulin (RhoGAM) to reduce the chance of missed abortion. Note that Rho GAM injections are not recommended before week 6th of pregnancy. 

Pelvic exam 

In the first three months of pregnancy, your healthcare provider checks your cervix repeatedly to make sure that it has not opened. If the cervix is open and you have mild abdominal pain, you are likely going through a silent miscarriage. 

Miscarriage tissue test 

A tissue test, also known as production of conception (POC), is done when the mother has passed a part of the fetal tissue and blood. This test examines and analyzes the tissue to confirm the miscarriage. The results of this test help you eliminate the chance of miscarriage in future pregnancies. 

Chromosomal test

Couples who have a history of miscarriage should take a chromosomal test to detect any abnormality in their genes and chromosomes. In some cases, the couple doesn’t have any chromosomal disorder, but the mixture of their chromosomes has an abnormal makeup and increases the risk of miscarriage.

Miscarriage Test Results

After taking tests and examinations, the doctor reveals their results as one of the following.

• Missed miscarriage: it demonstrates that the embryo has died. In a missed miscarriage, the placenta and fetal tissue do not come out right when the fetus dies, so the body does not show any symptoms.
• Threatened miscarriage: it shows that the cervix is not open and the pregnancy has not ended. But since you have vaginal bleeding, you are at the risk of losing your baby. Fortunately, such situations are managed by having enough rest and taking medication, and the pregnancy continues without any problem.
• Inevitable miscarriage: it shows that the fetus is lost, and the doctor should remove the remaining pregnancy tissues. This happens when you have severe vaginal bleeding and cramps, and your cervix is completely open. 
• Incomplete miscarriage: it describes that the fetus has perished, but some parts of the fetal tissue have not passed and have remained in the uterus. In such cases, dilatation and curettage (D&C) surgery is needed to remove tissue from the uterus.
• Complete miscarriage: it shows that the embryo is no longer alive and all the pregnancy tissues have passed from the uterus. 
• Septic abortion: if the residuals of miscarriage do not come out completely, they lead to uterine infection and cause fever, chills, pelvic pain, foul-smelling discharge, abnormal dizziness, and severe abdominal pain. 

Missed Miscarriage Treatment 

After diagnosing any type of miscarriage, including the silent one, all the remaining tissues of the pregnancy should be removed from the body. In most cases, two weeks after the diagnosis of missed abortion, the body expels the pregnancy tissue naturally. While your body is trying to pass placental and embryonic tissues, avoid having sexual intercourse, using tampons, and travelling. Tampons and intimacy increase the risk of uterine infection and can lead to disastrous events. 

If your test results have shown that you are going through a missed miscarriage, the doctor chooses one of the following treatment methods according to your physical and mental condition.

Expectant treatment

In about 65% of women who experience silent miscarriage, the pregnancy tissues are naturally passed from the body in 2 to 4 weeks. This treatment is only suggested when the patient has no signs of infection, such as fever and extreme fatigue. During the pregnancy treatment of missed abortion, you have to visit your doctor frequently until the fetal tissues are completely passed and your hCG level is normal again.

Medical treatment

If the pregnancy tissue is not removed naturally, you have to take medications like mifepristone and misoprostol. Medical treatment of missed miscarriage speeds up the abortion process and prevents uterine infection. It’s worth mentioning that Cytotec (misoprostol) is not an OTC medication and will be given to patients only in the hospital.

Surgical treatment

If the abortion is not completed naturally or with medications, the doctor performs dilation and curettage (D&C) surgery, also known as uterine aspiration. In this operation, which is done under general anesthesia, the surgeon opens up the cervix slowly and removes the pregnancy tissues with a spoon-like tool called a curette. This treatment has a longer recovery time and may damage the cervix or hurt the endometrium; however, it prevents uterine infection and cervical ulceration.  

Remember that after all missed abortion treatments, the mother should get a shot of Rh immunoglobulin if her blood type is Rh-negative. This shot will prevent a blood problem (like severe anemia) in future pregnancies. 

Recovery After Missed Abortion

The recovery time after a missed abortion can take a few days or even a few weeks. Usually, women have normal menstruation 4 to 6 weeks after miscarriage. If you have fever, chills, extreme pain in your lower abdomen, and heavy bleeding during your first period after abortion, you must contact a healthcare provider immediately. While you are recovering from a silent miscarriage, avoid having sex, inserting anything into your vagina, and strenuous activities. You can use all types of birth control methods during this time. 

In addition to physical problems, mothers also face post-traumatic stress disorder (PTSD) after a silent miscarriage. Get help from a therapist if you are too depressed, despaired, or angry. Also, talking to people who have had a history of missed abortions can help improve your mental state. Remember that such emotions are normal, and getting help from a professional is necessary. 

Pregnancy after Missed Miscarriage

It’s normal to be worried about future pregnancies after a missed miscarriage. The good news is that the chance of a second missed abortion is nearly zero. In other words, a silent miscarriage does not increase the chances of having another miscarriage in the future.

It is better to wait about 6 to 8 weeks after the miscarriage before trying to get pregnant again. This timeout helps your body recover and lets you prepare your mind for the next pregnancy. During this time, you should take regular ultrasounds and blood tests to find any chromosomal or blood disorder that may cause miscarriage again. Most people have %60 to %80 chance of having a healthy pregnancy after a silent miscarriage. 

For those considering in vitro fertilization (IVF) after a missed miscarriage, it's essential to consult with a fertility specialist. IVF treatment can offer a more controlled approach to conception, with careful monitoring and the ability to select the healthiest embryos. This can reduce the risk of another miscarriage due to chromosomal abnormalities. Additionally, IVF may provide an opportunity for genetic testing to detect potential issues early on, ensuring the best chances of a successful pregnancy. Ultimately, whether pursuing IVF or natural conception, maintaining a supportive relationship with healthcare professionals can help navigate the emotional and physical challenges associated with pregnancy after a miscarriage.

Fertility Treatment in Iran

A chromosomal deficiency, hormonal imbalance, infection of reproductive tracts, or mother’s health issues like thyroid and immunological disorders can cause miscarriage. Regardless of the cause of unwanted abortion, fertility specialists in Iran can help you have a full-term pregnancy and a healthy baby. Various surgical and medical treatments are available in Iran to treat underlying issues that lead to silent miscarriage. If you’d like to benefit from high-quality and affordable fertility treatments in Iran, contact Raadina Co. Our professional team is ready to help you find the best fertility doctors in Iran and show you the steps to take to get a medical visa.

Fertility Treatment in Iran

Conclusion 

Silent miscarriage happens in less than %5 of pregnancies, but it causes extreme physical and emotional distress in couples. Missed miscarriage doesn’t have any vivid symptoms as the uterus avoids pushing out the placental and embryonic tissue after the death of the baby. Accordingly, it is hard to diagnose this type of abortion without ultrasound imaging and other tests. There are three treatments for missed abortion: expectant management, medication therapy, and surgical treatment. The doctor chooses one of these methods based on your symptoms and overall health. 

FAQs about Missed Miscarriage 

1) Why do missed abortions happen?

It’s not yet clear why missed abortions happen, but fertility doctors believe that chromosomal abnormalities and hormonal imbalance are the main causes of this problem. 

2) What happens if you don’t remove a missed miscarriage?

If you leave the missed miscarriage untreated, the residual embryonic tissue causes severe infection, bleeding, and abdominal pain. All these complications may put your life at risk, so treating silent miscarriage is critical.  

3) How long does it take for the missed miscarriage to pass naturally?

It takes almost 4 weeks for the missed miscarriage to pass naturally. Note that in some cases, it might even take longer to lose the pregnancy tissue, so take ultrasound imaging frequently during this time. 

4) How can I deal with emotional distress after a missed abortion?

Get help from a therapist, talk to women who have experienced missed abortions before, talk to your sympathetic friends and families, practice yoga, and write about your emotions. 

5) Will I have a baby after a silent miscarriage?

Absolutely yes. 60 to 80 per cent of people who have experienced silent miscarriage can have a healthy baby after treating the underlying issue that had caused the unwanted abortion. You can try conceiving 6 to 8 weeks after a missed miscarriage. 

6) What should you do after a missed miscarriage?

You need to be monitored by a gynecologist for a few weeks after a missed miscarriage. You should take medications if you have signs of infection or hormonal imbalance.