How Do Health Care Providers Diagnose and Treat Pregnancy Loss (Before 20 Weeks of Pregnancy)?

If a pregnant woman has any of the symptoms of pregnancy loss, such as abdominal cramps, back pain, light spotting, or bleeding, she should contact her health care provider immediately. Remember that vaginal bleeding during pregnancy does not definitely mean a pregnancy loss is occurring.

Diagnosing Pregnancy Loss

Depending on how far along the pregnancy is, health care providers may use different methods to determine whether a pregnancy loss has occurred:

  • A blood test to check the level of human chorionic gonadotropin (hCG), the pregnancy hormone
  • A pelvic exam to see whether the woman's cervix is dilated or thinned, which can be a sign of pregnancy loss
  • An ultrasound test, which allows the provider to look at the pregnancy, uterus, and placenta11

If a woman has had more than one miscarriage, she may want to have a health care provider check her blood for chromosome problems, hormone problems, or immune system disorders that may be contributing to pregnancy loss.2

Treating Pregnancy Loss

Treatments for pregnancy loss focus on ensuring that the nonviable pregnancy leaves the woman's body safely and completely. Women going through pregnancy loss are at risk for bleeding, pain, and infection, especially if some of the pregnancy tissue remains behind in the uterus.

The specific treatment used depends on how far along the pregnancy was, the woman's overall health, her age, and other factors.1

In many cases, pregnancy loss before 20 weeks may not require any special treatment. The bleeding that occurs with pregnancy loss empties the uterus without any further problems.

Women who have heavy bleeding during pregnancy loss should contact a health care provider immediately. For reference, heavy bleeding refers to soaking at least two maxi pads an hour for at least 2 hours in a row.1

Some women may need a surgical procedure called a dilation and curettage (D&C) to remove any pregnancy tissue that is still in the uterus. A D&C is recommended if a woman is bleeding heavily or if an ultrasound shows pregnancy tissue is still in the uterus. D&C may also be used if a woman has any signs of infection, such as a fever, or if she has other health problems, such as cardiovascular disease or a bleeding disorder.1

Some women are treated with a medication called misoprostol, which helps the tissue pass out of the uterus and controls the resulting bleeding. Research shows that misoprostol is safe and effective in most cases.1,3

Women who lose a pregnancy may also need other treatments to control mild to moderate bleeding, prevent infection, relieve pain, and help with emotional support.

Although this is rare in the United States, some women who have a miscarriage may get an infection in the uterus, which can be life threatening. Women who have the following symptoms more than 24 hours after treatment should call 911:4

  • A fever higher than 100.4 degrees Fahrenheit on more than two occasions
  • Severe pain in the lower abdomen
  • Bloody discharge from the vagina that includes pus or is foul smelling

Citations

  1. American College of Obstetricians and Gynecologists. (2015). Early pregnancy loss. Practice Bulletin No. 150. Obstetrics & Gynecology, 125, 1258–1267. Retrieved February 23, 2017, from http://www.acog.org/Resources-And-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Early-Pregnancy-Loss 
  2. American Society for Reproductive Medicine. (2012). Evaluation and treatment of recurrent pregnancy loss: A committee opinion. Fertility and Sterility, 98(5), 1103–1111. Retrieved February 23, 2017, from http://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-non-members/evaluation_and_treatment_of_recurrent_pregnancy_loss_a_committee_opinion-noprint.pdf  (PDF - 294 KB)
  3. NICHD. (2005). Drug offers alternative to surgical treatment after miscarriage. Retrieved July 24, 2017, from https://www.nichd.nih.gov/news/releases/Pages/pregnancy_failure.aspx
  4. Nyirjesy, P., & Brandt, K. A. (2016). 54: Infections of the female pelvis, including septic abortion. In J. Cohen, W. G. Powderly, & S. M. Opal (Eds.), Infectious Diseases, 4th ed., vol. 1 (pp. 492–497.e1). Elsevier.

What are common symptoms?

Causes and Risks

How is it diagnosed?

Is there a way to prevent?

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