Signs, symptoms and diagnosis
Bleeding, sometimes alongside pain, is a common sign of miscarriage. It doesn’t always mean that a miscarriage is happening, but it’s important to have it checked by your GP or Early Pregnancy Unit so you can receive the appropriate care.
When to call 999 or get urgent help?
If you have severe abdominal pain that makes it difficult to focus on everyday tasks, pain in your shoulder tip – which could be a sign of ectopic pregnancy – or if you feel sick, faint, or lose consciousness, it’s important to seek urgent help.
Heavy bleeding can also be a sign that you need immediate care, especially if you soak through a period pad very quickly after putting it on. In any of these situations, please call 999.
Signs and symptoms
While this information is here to support and guide you, it can’t replace individual medical advice. If something doesn’t feel right, or you’re worried about your symptoms, please contact your GP, Early Pregnancy Unit or local hospital.
Some discomfort is common in early pregnancy. Ligaments stretch as your body changes, causing mild abdominal or back ache. Stomach upsets, constipation or wind, can also create abdominal discomfort. It doesn’t always mean a miscarriage, but it’s always worth getting your symptoms checked by a healthcare professional.
If you have acute abdominal or one-sided pain, shoulder pain, or pain when passing stools, it’s important to contact your GP, Early Pregnancy Unit (EPU) or midwife. If necessary, go to A&E and let staff know you are pregnant so they can arrange an urgent scan.
If you’ve had a previous ectopic pregnancy and are experiencing pain ask for an early scan to check the pregnancy is developing in the right place.
Spotting or bleeding does not automatically mean a miscarriage. Research shows that around half of women attending an EPU with bleeding go on to have a continuing pregnancy.
Bleeding in pregnancy can take many forms — light or heavy, bright or dark, continuous or on-and-off, with or without clots. It’s worth keeping a track of what the bleeding is like so you can tell a healthcare professional. Make a note about how much there is, and whether there are any big lumps or clots.
Use a clean sanitary pad or period pants. Try not to use tampons, menstrual cups, or anything inserted into the vagina, as this can increase the risk of infection.
If you are bleeding so heavily that you soak more than one medium-sized pad an hour, do seek medical help from your GP, NHS 111, your nearest Early Pregnancy Unit or A&E department.
Many early pregnancy symptoms – such as nausea, fatigue, breast tenderness and needing to urinate more often – are very common. Having these symptoms, or noticing that they suddenly stop, doesn’t necessarily mean you are having a miscarriage. Equally, having no symptoms doesn’t always mean that everything is fine.
If you experience a sudden gush of fluid from your vagina, this could be a sign of miscarriage and it’s important to contact your GP or Early Pregnancy Unit.
Diarrhoea can also be a symptom of miscarriage or an ectopic pregnancy. If you have diarrhoea alongside stomach pain, or any of the other symptoms mentioned above please seek medical advice.
Pregnancy can be unpredictable, and symptoms alone are not a reliable guide. If something doesn’t feel right, trust your instincts: speak to your GP or midwife (if you have one), or contact us to talk it through.
Diagnosing a miscarriage
If you are experiencing symptoms of pregnancy loss, you may be able to refer yourself to your local Early Pregnancy Unit, or you may need to speak to your GP and ask them to refer you. At the hospital, you will be asked about your symptoms and urine and blood tests might be taken.
You may also be offered an ultrasound scan, depending on the gestation of your pregnancy. It isn’t usually possible to see a heartbeat on a scan until after six weeks. Sometimes the pregnancy is not visible and it’s not clear what is happening – this is often referred to as a pregnancy of unknown location (PUL). You may be asked to come back for another scan, possibly in a week or two when things should be clearer. Or if the doctor thinks you might have an ectopic pregnancy, you will have blood tests and/or a laparoscopy (keyhole surgery to look inside the abdomen).
You might also be asked to go home to wait and see what happens, or wait for the results of a blood test. This can be an anxious time and it’s important to reach out for support.
If you haven’t told anyone that you’re pregnant, you can always talk to us.
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Frequently asked questions
An early pregnancy unit (EPU) can support you with any concerns – primarily pain or vaginal bleeding – you may have before 15+6 weeks of pregnancy. Every EPU is different, but they should ask you about your symptoms and, if appropriate, take you to have an ultrasound scan by an experienced sonographer or senior doctor. If a miscarriage is diagnosed, they will discuss the different options that are available to you.
If your Early Pregnancy Unit refers you for an ultrasound scan, it’s likely to be for an internal scan if you’re only a few weeks into your pregnancy, as this gives the most accurate picture.
There are two types of scan:
Trans-vaginal (internal) scan
In early pregnancy, especially before 11 weeks, it is usual to have Trans-vaginal (internal) scan where a probe is placed in the vagina. This gives the clearest and most accurate picture in early pregnancy. It may also be offered after 11 or 12 weeks if a trans-abdominal scan doesn’t give a clear enough picture.
Trans-abdominal scan
From 11 or 12 weeks, including at the routine ‘booking-in’ scan at your hospital, it is more common to have a trans-abdominal scan. The person doing the scan spreads a gel on your lower abdomen. They then move the scanner over the gel, sometimes pressing down, until the uterus (womb) and pregnancy can be seen.
If you don’t want a trans-vaginal scan, you can ask for a trans-abdominal scan. In the first 11 or 12 weeks, this may give some information about your pregnancy, but it is less clear than an internal scan and that could possibly delay diagnosis.
There is no evidence that having a vaginal or an abdominal scan will cause a miscarriage or harm your baby. If you bleed after a vaginal scan, it will most likely be because there was already blood pooled higher in the vagina and the probe dislodged it.
An ultrasound scan may be able to detect a pregnancy and a heartbeat in a normal pregnancy at around 6 weeks, but this varies a great deal and isn’t usually advised. All too often, a scan at 6 weeks shows very little or nothing, even in a perfectly developing pregnancy, and that might actually make you more anxious. Coping with uncertainty can be very difficult but waiting a week or 10 days will make the findings much clearer.
If your GP won’t refer you for a scan, it might be because it is too early to be able to see even a healthy pregnancy on a scan. It might be that they take a “wait and see” approach and advise you to stay at home and rest.
You might find this very frustrating and even frightening, especially if you are feeling very anxious.
If you want a scan because of bleeding or spotting, and you can’t get an appointment at an Early Pregnancy or Emergency Gynaecology Unit, you could go to your nearest Accident & Emergency Department. Bear in mind that you might have a long wait and that they might not be able to scan you there and then.
If you want a scan for reassurance, you might decide to go for a private scan. Clinic standards do vary so it is best to check:
- if their sonographers (scan operators) are qualified radiographers, or midwives or nurses who are trained in ultrasound scanning
- if they offer diagnostic scans (ones that check for a heartbeat and other signs of a normally developing pregnancy)
- if they state that they refer women to NHS services if there or any concerns or uncertainties
- if they are registered with the Care Quality Commission (CQC) if in England, the Care Inspectorate in Scotland and Wales or the Regulation and Quality Improvement Authority (RQIA) in Northern Ireland.
The ultrasound scan may show:
- A viable ongoing pregnancy. There is a heartbeat (or heartbeats if it’s a twin or multiple pregnancy) and the pregnancy is the “right size for dates” – that is, the size that would be expected based on the first day of your last period. Those are positive signs, but if you continue to bleed, you may need a further scan in a week or two to check what’s happening.
- An ongoing pregnancy that suggests a problem. The pregnancy may be much smaller than it should be according to dates or the heartbeat might be particularly slow or faint which could suggest a problem with the baby’s development. With a twin or multiple pregnancy, the scan may show that one (or more) baby has a heartbeat and one (or more) doesn’t. You may be asked to come back for another scan, possibly in a week or two when things should be clearer.
- A pregnancy of unknown location (PUL). The pregnancy is not visible and it’s not clear what is happening. You may be asked to come back for another scan, possibly in a week or two when things should be clearer. Or if the doctor thinks you might have an ectopic pregnancy, you will have blood tests and/or a laparoscopy (keyhole surgery to look inside the abdomen).
- A complete miscarriage. The pregnancy has miscarried. There may still be a small amount of pregnancy tissue or blood in the uterus.
- A non-viable pregnancy. This means a pregnancy that hasn’t survived but hasn’t yet miscarried. You may hear this described as a Missed Miscarriage, Early embryo loss, or an Incomplete miscarriage where the process of miscarriage has started but there is still pregnancy tissue in the uterus (womb) and you may still have pain and heavy bleeding.
In all of these situations, the pregnancy will fully miscarry with time, but there are several ways of managing the process. You may be offered a choice, or the hospital might make a recommendation. In most cases, you should be able to have time to think about what you can best cope with.
In some cases, if there is no sign of a pregnancy in the uterus, you may be given a blood test and possibly asked to return two days later for a repeat test.
These blood tests measure the level of the pregnancy hormone ßhCG. In a normally developing pregnancy the hormone levels double roughly about every 48 hours and if the pattern is different, this can help to identify what is happening to the pregnancy.
If there is no sign of a pregnancy in the uterus and you have symptoms that suggest ectopic pregnancy, you are more likely to have both a blood test and an investigation called a laparoscopy, which is done under general anaesthetic.
