Miscarriages are classed as early or late miscarriages. An early miscarriage occurs within the first 12 weeks of pregnancy. 

Signs and symptoms 

Bleeding in pregnancy may be light or heavy, dark or bright red.  You may pass clots or “stringy bits”.  You may have more of a discharge than bleeding. Or you may have spotting, which you notice on your underwear or when you wipe yourself.

Spotting or bleeding may be continuous or it might be on and off, perhaps over days or even weeks.  It doesn’t necessarily mean that you are miscarrying or that you will miscarry, but it’s always worth checking.

Pain, like bleeding, can vary.  Abdominal pain might be due to a stomach upset or constipation, and backache is common in normal pregnancy, especially as the weeks go by.  But if you have bleeding or spotting as well as pain, that might be a sign of miscarriage.

Lack or loss of pregnancy symptoms can also sometimes be a sign of miscarriage, but like pain and bleeding, that doesn’t necessarily mean there is a problem.  Some women have very little in the way of pregnancy symptoms, and many feel differently in different pregnancies.

But if you have strong pregnancy symptoms which suddenly reduce or stop well before 12 weeks of pregnancy, that might mean that hormone levels are dropping.  You may want to do another pregnancy test and/or talk to your GP about perhaps having a scan.

In some cases, there are no signs at all that anything is wrong and miscarriage is diagnosed only during a routine scan. 

The main sign of a miscarriage is vaginal bleeding, which may be followed by cramping and pain in your lower abdomen.

If you have vaginal bleeding, contact your GP or midwife. Most GPs can refer you to an early pregnancy unit at your local hospital straight away if necessary. You may be referred to a maternity ward if your pregnancy is at a later stage.

However, bear in mind that light vaginal bleeding is relatively common during the first trimester of pregnancy (the first 12 weeks) and doesn't necessarily mean you are having a miscarriage.

There are probably many reasons why a miscarriage may happen, although the cause isn't usually identified. The majority aren't caused by anything the mother has done.

It's thought most miscarriages are caused by abnormal chromosomes in the baby. Chromosomes are genetic "building blocks" that guide the development of a baby. If a baby has too many or not enough chromosomes, it won't develop properly.

If a miscarriage happens during the second trimester of pregnancy (between weeks 14 and 26), it's sometimes the result of an underlying health condition in the mother.

For most women, a miscarriage is a one-off event and they go on to have a successful pregnancy in the future.

The majority of miscarriages can't be prevented. If a woman has suffered from more than three miscarriages, some women can be helped to keep their pregnancy with medication under the care of a specialist.

However, there are some things you can do to reduce the risk of a miscarriage. Avoid smoking, drinking alcohol and using drugs while pregnant. Being a healthy weight before getting pregnant, eating a healthy diet and reducing your risk of infection can also help.

Miscarriages are much more common than most people realise. Among women who know they're pregnant, it's estimated one in six of these pregnancies will end in miscarriage. Many more miscarriages occur before a woman is even aware she has become pregnant.

Losing three or more pregnancies in a row (recurrent miscarriages) is uncommon and only affects around 1 in 100 women.

The physical process of miscarriage can vary.  It often depends on the size of the pregnancy and on whether the loss happens naturally or as a result of medical or surgical management

Early loss

If you miscarry naturally, even in the early weeks of pregnancy, you are likely to have period-like cramps that can be extremely painful.  This is because the uterus is tightly squeezing to push its contents out, like it does in labour – and some women do experience contractions not unlike labour. You are also likely to bleed heavily and to pass large clots.  You may pass a recognisable baby or fetus, perhaps still in the pregnancy sac.

You may feel able to manage the pain and bleeding at home or you might feel that you need to go to hospital.  If you’re not sure, contact your GP, out of hours service or 111 (England & Scotland) or 0845 46 47 (Wales).

Later loss

If you miscarry naturally in the second trimester, you are likely to go through a recognisable process of labour and you will probably need hospital care.  However, some women don’t have clear signs of labour and may deliver quickly at home. 

Missed or incomplete miscarriage

If an ultrasound scan shows that your pregnancy has ended but the process of miscarriage hasn’t started or completed, you will usually offered a choice about how to manage the situation:

Natural management (also called expectant or conservative management): letting nature take its course

Medical management: using medication to begin or speed up the process of miscarriage

Surgical management (also called SMM): an operation to remove the pregnancy

It may help to know that research [1] comparing natural, medical and surgical management found that:

the risks of infection or other harm are very small with all three methods

your chances of having a healthy pregnancy next time are equally good whichever method you choose

women cope better when given clear information, good support and a choice of management methods.

Natural management

Some women prefer to wait and let the miscarriage happen naturally – and hospitals may recommend this too, especially in the first three months of pregnancy.

It can be difficult to know what to expect and when (it may take days or weeks before the miscarriage begins) but most women will experience abdominal cramps, possibly quite severe, and pass blood clots as well as blood.

Medical management

This means treatment with pills and/or vaginal tablets (pessaries) to start or speed up the process of a delayed or missed miscarriage. Some women experience quite severe abdominal cramps as well as heavy bleeding with this option, but they may prefer this to an operation.

If your baby has died after about 14 or 15 weeks, you are most likely to be managed medically.

Hospitals sometimes differ in the way they give the treatment – for example, whether treatment is carried out in hospital or at home.  In all cases, though, they should give you clear information about what to expect.

Surgical management of miscarriage (SMM)

This is an operation to remove the remains of your pregnancy.  It is usually done under general anaesthetic but in some hospitals it can be done under local anaesthetic, when you stay awake. 

For many years, surgical management of miscarriage was called ERPC, an abbreviation for Evacuation of Retained Products of Conception, which means the removal of the remains of the pregnancy and surrounding tissue. Many people find this term upsetting, which is why it should not be used any more, but you might still hear it or see it written.

(Some people still call it a D & C, which is a slightly different procedure.)