What Is a Missed Miscarriage?

A missed miscarriage (also called a silent miscarriage) occurs when a fetus has died but remains in the uterus. In a silent miscarriage, a person usually does not have any signs or symptoms alerting them that something is wrong.

Usually, a miscarriage will cause bleeding, pain, or other symptoms. When a missed miscarriage happens, there are no symptoms, and a diagnosis is often only made during a routine ultrasound.

A prenatal care ultrasound might show that the fetus is not growing appropriately (too small for gestational age), that the heart is not beating, or both. These findings may come as a shock to the parent, as there were no signs that anything was wrong with the pregnancy.

Sometimes, if the fetal heartbeat is undetectable and gestational growth is not on track, another scan might be ordered a week to 10 days later.

A image of an ultrasound being performed.

John Fedele / Getty

What Is a Missed Miscarriage?

A missed miscarriage occurs when the fetus has died or ceased to develop in utero but has not yet been physically miscarried. Most often, there are no signs and a pregnant person is not aware that anything was wrong.

Causes

Physical miscarriages can occur within hours, days, or weeks of fetal death. The onset varies from person to person. With a missed miscarriage, it takes longer for a pregnant person’s hormone levels to drop and a physical miscarriage to happen.

The decreased hormone levels may result in a delayed miscarriage that lasts several days or even weeks.

The reason a missed miscarriage occurs and the person's hormone levels do not drop right away is not well understood.

Signs and Symptoms

When a pregnant person has a miscarriage, it usually begins with pain similar to menstrual cramps and vaginal bleeding. With a missed miscarriage, these signs do not occur.

Even though a silent miscarriage has occurred, pregnancy hormones are still high. Therefore, a pregnant person may continue to experience pregnancy symptoms such as breast tenderness, nausea, and fatigue, and a pregnancy test may continue to show a positive result.

If a missed miscarriage happens before the second trimester, it’s still too early to feel fetal movement. This means the absence of movement would not alert the person that they have miscarried.

Diagnosis

Ultrasound

When a missed miscarriage occurs, it is usually detected when a routine ultrasound scan is done at a prenatal appointment. 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 the fetus appears smaller than it should be and there is no heartbeat.

The scan could also show an empty amniotic sac or no sac at all. In this instance, the fetus stopped developing at a very early stage and has been reabsorbed by the body. Sometimes this is referred to as embryonic demise.

Treatment

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 intervention
  • Taking medication to induce the physical miscarriage
  • Having a surgical procedure (such as a dilation and curettage) to remove the fetus

Coping

When a missed miscarriage is diagnosed, the initial emotional reaction is often shock—particularly for those who had no physical signs or symptoms of an abnormal pregnancy.

Sometimes, a person has mild symptoms or simply a "hunch" that something is not right. However, even if there were signs that something was not right, it doesn't mean a person will be any less devastated by the diagnosis.

Having a Second Ultrasound


When a missed miscarriage occurs early in pregnancy and the ultrasound shows the fetus is too small for the gestation period, a pregnant person might be told to wait until the next ultrasound to ensure there is no fetal heartbeat.

The waiting period can be agonizing for a pregnant person and their loved ones.

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, there are medications and medical procedures that can be used to complete the miscarriage.

A Word From Verywell

A missed miscarriage often happens without any warning signs that something was wrong. 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 on what you will do next.

When you are ready, your doctor 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.

You might also find online or in-person support groups for people who have experienced miscarriage helpful as you navigate the grief of pregnancy loss.

Frequently Asked Questions

What causes a missed miscarriage?

The exact cause of a missed miscarriage is not known. In general, genetic problems might play a role in pregnancy loss, but it is not clear why some people experience silent miscarriages.

How common are missed miscarriages?

It's not known exactly how common silent miscarriages are, but one study estimated that missed miscarriages occur in around 3% of pregnancies.

How long does it take to miscarry naturally after a missed miscarriage?

It can take several days or even weeks for a physical miscarriage to occur when a person has had a missed miscarriage.

How early can you have a missed miscarriage?

Miscarriages most often happen during the first trimester of pregnancy (by definition, a miscarriage occurs before 20 weeks). About 80% of miscarriages occur in the first trimester.

What are the signs of a missed miscarriage? 

There are usually no signs of a missed miscarriage. In some instances, a person might have cramping or some brownish pink or red vaginal discharge.

Often, the symptoms of pregnancy, such as breast tenderness, nausea, or fatigue, continue when a silent miscarriage has happened. However, some people might notice that these symptoms begin to subside when a missed miscarriage has occurred.

Was this page helpful?
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Condous G. Ultrasound diagnosis of miscarriage: new guidelines to prevent harmAustralas J Ultrasound Med. 2011;14(4):2. doi:10.1002/j.2205-0140.2011.tb00127.x

  2. Miscarriage Association. Missed miscarriage.

  3. The Royal Women’s Hospital. Treating miscarriage.

  4. Stamatopoulos N, Condous G. Ultrasound follow-up in the first trimester when pregnancy viability is uncertainAustralasian Journal of Ultrasound in Medicine. 2017;20(3):95-96. doi:10.1002/ajum.12063

  5. Pandya PP, Snijders RJ, Psara N, et al. The prevalence of non-viable pregnancy at 10-13 weeks of gestationUltrasound Obstet Gynecol. 1996;7(3):170-173. doi:10.1046/j.1469-0705.1996.07030170.x

  6. Cohain JS, Buxbaum RE, Mankuta D. Spontaneous first trimester miscarriage rates per woman among parous women with 1 or more pregnancies of 24 weeks or moreBMC Pregnancy Childbirth. 2017;17(1):437. doi:10.1186/s12884-017-1620-1