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The physical and emotional toll on someone experiencing pregnancy loss should never be underestimated because miscarriage can be one of the most traumatic moments in a person’s life.
In some cases, a person can even have a miscarriage without knowing it, or before they know they’re pregnant. While this occurrence is colloquially known as a “missed” miscarriage, those in the medical field prefer to use terms like asymptomatic early pregnancy loss, blighted ovum, or anembryonic pregnancy instead.
“An anembryonic pregnancy occurs when a fertilized egg successfully attaches itself to the uterus, yet the subsequent embryo fails to progress in development,” explains Layan Alrahmani, M.D., a board-certified OB/GYN and maternal-fetal medicine specialist. This results in a pregnancy where the undeveloped embryo is resorbed, leaving behind an empty gestational sac, or, in other words, “retained embryonic/placental tissue in the uterine cavity,” says Kecia Gaither, M.D., a board-certified OB/GYN and Director of Perinatal Services/Maternal Fetal Medicine at NYC Health + Hospitals in the Bronx, New York.
Unfortunately — and this is what makes this kind of pregnancy loss so much more distressing — having a missed miscarriage means “the mother typically does not experience any symptoms of a miscarriage,” says Dr. Alrahmani. “Typical symptoms of a miscarriage would include vaginal bleeding or spotting and abdominal pains.” If a patient has a missed miscarriage, they may not feel anything at all.
How common is asymptomatic early pregnancy loss?
While 10% to 20% of pregnancies end in miscarriage, it’s very likely that this number is much higher due to missed miscarriages.
Detecting asymptomatic early pregnancy loss has become increasingly more common thanks to “the use of high-sensitivity pregnancy tests and ultrasounds in early pregnancy,” says Kelly Culwell, M.D., a board-certified OB/GYN also known as Dr. Lady Doctor. “Prior to the regular use of these technologies, women would not know they were experiencing a pregnancy loss until they started to actively miscarry.”
An ultrasound will confirm the missed miscarriage by “showing either a lack of development of an embryo or lack of cardiac activity in an embryo or fetus of a certain size when cardiac activity would be expected,” says Dr. Culwell.
Although there are usually no symptoms of this kind of pregnancy loss — which is why missed miscarriages can only be confirmed via ultrasound — Dr. Culwell does say it’s possible to notice a lessening of typical pregnancy symptoms like nausea or breast tenderness. This is due to the decrease of the pregnancy hormone hCG in your blood.
What is the main cause of a missed miscarriage?
The main cause of asymptomatic early pregnancy loss is no different than a miscarriage with symptoms, which is that the unborn baby didn’t develop properly. “The majority of [‘missed’ miscarriages] are due to chromosomal abnormalities,” says Dr. Gaither.
It’s always important to remember that this loss, as with any other pregnancy loss, is “completely out of the pregnant mom’s control,” assures Dr. Alrahmani. So seek out professional help if you are experiencing feelings of despair: “These miscarriages are not their fault, but they can cause women to feel guilty and can take a toll on their mental health.”
What are my options once the miscarriage is confirmed?
This is the last thing anyone facing a potential miscarriage wants to hear, but Dr. Culwell warns that it may take more than one ultrasound to diagnose an early pregnancy loss. This is because, in some cases, the diagnosis “requires a lack of growth or progression of the pregnancy over time (usually 1-2 weeks).”
Once the miscarriage is confirmed, however, depending on the clinical presentation, there are typically three options, says Dr. Gaither. They are:
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Expectant management: The pregnancy will pass on its own.
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Medical management: Medication (such as mifepristone combined with misoprostol) is prescribed to cause contractions, which in turn will expel the pregnancy.
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Surgical management: A procedure called Dilation and Curettage (D&C) is performed to remove the pregnancy from the uterus
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Dr. Culwell says, "About 50% of asymptomatic pregnancy losses will pass spontaneously within 14 days.” However, after the 14-day point, medical intervention is more likely because there is now an increased risk of complications such as infection. “Every situation is different, however,” says Dr. Culwell. “Your healthcare provider should be able to counsel you on how long you can wait for the pregnancy to pass on its own based on your individual circumstances.”
After pregnancy loss
Like any other pregnancy loss, a missed miscarriage can be devastating for expectant parents. “Women who experience miscarriages, including missed miscarriages,” says Dr. Alrahmani, “may face a variety of understandable effects to their mental health, many of which can be severe and long-lasting, including grief, sadness, depression, and even post-traumatic stress disorder (PTSD).” If you need mental health support following a miscarriage, do not hesitate to ask your medical provider for a referral.
Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Visit her website here, or follow her on Instagram or Twitter.