Early Pregnancy Loss
What is Early Pregnancy Loss?
Early pregnancy loss occurs when a pregnancy stops developing during the first 20 weeks of pregnancy. It is a common complication of pregnancy and can be both physically and emotionally challenging.
Early pregnancy loss includes both miscarriage and ectopic pregnancy. An ectopic pregnancy occurs when a pregnancy implants outside the uterus and is discussed separately in the CHARLI information sheet on ectopic pregnancy.
A miscarriage occurs when a pregnancy is no longer developing and is unable to continue.
What types of miscarriage are there?
Your doctor may use different terms depending on what is happening during the pregnancy.
Threatened miscarriage
A threatened miscarriage occurs when there is vaginal bleeding or pelvic pain, but the pregnancy is still developing and remains viable.
Incomplete miscarriage
An incomplete miscarriage occurs when the pregnancy is no longer viable, but some pregnancy tissue remains within the uterus.
Bleeding and cramping are common, and treatment may be required to help the uterus empty completely.
Complete miscarriage
A complete miscarriage occurs when all pregnancy tissue has passed naturally from the uterus.
Bleeding and pain usually settle over time once the miscarriage is complete.
Pregnancy of unknown location
A pregnancy of unknown location refers to a situation where a pregnancy test is positive but the pregnancy cannot yet be seen on ultrasound.
This does not necessarily mean the pregnancy is abnormal. Further blood tests and repeat ultrasound examinations are usually required to determine whether the pregnancy is developing normally, has miscarried, or is an ectopic pregnancy.
How common is Early Pregnancy Loss?
Early pregnancy loss is unfortunately very common.
Approximately one in four pregnancies end in miscarriage, depending on the age of the woman.
Although miscarriage is common, that does not lessen the impact it can have. Every person’s experience is different, and the emotional response is individual.
What are the symptoms of Early Pregnancy Loss?
Symptoms vary depending on the type of pregnancy loss.
They may include:
- vaginal bleeding
- pelvic or abdominal pain
- cramping
- passing blood clots or pregnancy tissue.
Some women notice that pregnancy symptoms such as nausea, breast tenderness or fatigue begin to settle.
It is important to remember that vaginal bleeding, pain and changes in pregnancy symptoms can also occur in healthy ongoing pregnancies. These symptoms do not always indicate that a pregnancy has been lost.
In some cases, early pregnancy loss causes no symptoms and is first identified during a routine ultrasound examination.
How is Early Pregnancy Loss diagnosed?
Diagnosis is based on a combination of your symptoms, blood tests and ultrasound findings.
Your doctor may recommend:
- a blood test to measure the pregnancy hormone (human chorionic gonadotrophin or hCG)
- repeat blood tests over several days to assess whether hormone levels are rising as expected
- an ultrasound examination, which may include a transvaginal (internal) ultrasound, to determine the location and development of the pregnancy.
If the pregnancy is sufficiently advanced, the ultrasound will also assess whether a fetal heartbeat is present.
What are the treatment options?
The most appropriate treatment depends on your symptoms, the stage of pregnancy and your individual circumstances.
Your doctor will discuss the advantages and disadvantages of each option with you.
Surgical management
A procedure called a curette (also known as dilation and curettage or D&C) removes pregnancy tissue from the uterus.
The procedure is performed in hospital under anaesthesia and is highly effective.
Medical management
Medication may be used to help the uterus pass the pregnancy tissue naturally.
This commonly involves misoprostol, with or without mifepristone.
Following treatment, cramping and vaginal bleeding are expected as the uterus empties.
Expectant management
In some situations, no immediate treatment is required.
This approach, sometimes called watchful waiting, allows the body to pass the pregnancy tissue naturally.
Although effective for many women, this process can take days or, occasionally, several weeks.
How effective is treatment?
All three treatment approaches are effective, although success rates differ.
Surgical management is successful in almost 100% of cases. As with any procedure, there is a small risk of complications, including the need for repeat surgery or the development of scar tissue within the uterus.
Medical management is successful in approximately 70–90% of cases, depending on how advanced the pregnancy is and the medications used. Some women will still require surgical treatment if the miscarriage is incomplete.
Expectant management is successful in around 50–70% of cases. Success depends largely on the stage of pregnancy and the individual circumstances.
What can I expect?
Recovery following early pregnancy loss is different for everyone.
Physical recovery often occurs over days to weeks, while emotional recovery may take considerably longer. Some people feel ready to try for another pregnancy relatively quickly, while others need more time.
Your healthcare team can discuss when it is medically appropriate to try to conceive again and provide support if you have concerns about future pregnancies.
What to remember
Early pregnancy loss is common, but every experience is unique.
Whether treatment involves surgery, medication or expectant management, your healthcare team will work with you to determine the most appropriate approach based on your circumstances.
If you have questions about future pregnancies or recurrent pregnancy loss, discuss these with your GP or fertility specialist, who can guide you through the next steps.
Further information
For additional information and support following pregnancy loss, visit SANDS Australia, which provides evidence-based resources and support for individuals and families affected by miscarriage and pregnancy loss.
This article is intended for educational purposes only and should not replace personalised medical advice, diagnosis or treatment. Every article is written by a qualified specialist clinician and independently reviewed by a second specialist clinician to help ensure clinical accuracy and reflect current evidence-based practice.
