[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Miscarriage (early pregnancy loss)

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# Miscarriage (early pregnancy loss)

A miscarriage is the spontaneous loss of a pregnancy before the baby can survive, usually before 20 weeks; most happen in the first three months.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Body of uterus](https://durgical.com/en/anatomy/body-of-uterus/)
- [Endometrium](https://durgical.com/en/anatomy/endometrium/)
- [Cervix](https://durgical.com/en/anatomy/cervix-of-uterus/)
- [External os](https://durgical.com/en/anatomy/external-os-of-uterus/)
- [Vagina](https://durgical.com/en/anatomy/vagina/)
- [Myometrium](https://durgical.com/en/anatomy/myometrium/)

## In embryology

- [Trophoblast and hCG; gestational trophoblastic disease](https://durgical.com/en/embryology/trophoblast-and-hcg-gestational-trophoblastic-disease/)
- [Principles of teratology: critical periods, dose and genotype](https://durgical.com/en/embryology/principles-of-teratology-critical-periods-dose-and-genotype/)
- [Alcohol: fetal alcohol spectrum disorder](https://durgical.com/en/embryology/alcohol-fetal-alcohol-spectrum-disorder/)
- [Methotrexate and misoprostol](https://durgical.com/en/embryology/methotrexate-and-misoprostol/)

## In physiology

- [The placenta and pregnancy hormones](https://durgical.com/en/physiology/the-placenta-and-pregnancy-hormones/)
- [Fertilization and implantation](https://durgical.com/en/physiology/fertilization-and-implantation/)

## Why it happens

- [Chromosome abnormalities: number and structure](https://durgical.com/en/general-pathology/chromosome-abnormalities-number-and-structure/)
- [Fertilisation, implantation and the decidua](https://durgical.com/en/histology/fertilisation-implantation-and-the-decidua/)

## What it is

Spontaneous loss of an intrauterine pregnancy before the fetus can survive, usually defined as before 20 weeks; some definitions use 22 weeks or fetal weight. Most occur in the first trimester (early pregnancy loss).

## Who gets it

The most common complication of early pregnancy; many losses happen before a pregnancy is even recognised. Risk rises clearly with maternal age. In most cases nothing the woman did caused it.

## Causes

- Chromosomal abnormalities of the embryo, the most common cause in the first trimester
- Uterine anomalies (septum, submucosal fibroids, intrauterine adhesions)
- Antiphospholipid syndrome
- Poorly controlled diabetes or thyroid disease
- Infections and cervical insufficiency (more in the second trimester)

## Risk factors

- Older maternal age
- Previous miscarriages
- Smoking, alcohol and other drugs
- Obesity or very low body weight
- Uncontrolled chronic disease

## Pathophysiology

Most early losses come from abnormal embryonic development, often from a random chromosomal error. When the embryo stops developing, hormonal support falls, the decidua breaks down and the uterus starts to expel the pregnancy, causing bleeding and cramps. Sometimes the non-viable pregnancy stays in the uterus without symptoms.

## Classification

- Threatened: bleeding with a closed cervix and a viable pregnancy
- Inevitable: bleeding with an open cervix, tissue not yet passed
- Incomplete: part of the tissue passed, cervix open, tissue remains
- Complete: all tissue passed, cervix closed, uterus empty
- Missed: non-viable pregnancy retained with a closed cervix, often without symptoms
- Septic miscarriage; recurrent pregnancy loss (definitions vary)

## Symptoms and signs

- Vaginal bleeding, from spotting to heavy
- Cramping lower abdominal or back pain
- Passage of tissue
- Loss of pregnancy symptoms
- No symptoms in a missed miscarriage (found on ultrasound)

## Red flags

- Heavy bleeding or signs of shock
- Fever, foul-smelling discharge or uterine tenderness (septic miscarriage)
- One-sided pain or free fluid on ultrasound (possible ectopic pregnancy)

## Diagnosis

**Clinical**
Speculum examination to see whether the [cervix](https://durgical.com/en/anatomy/cervix-of-uterus/) is open and whether tissue is present; vital signs and assessment of blood loss.

**Tests**
Quantitative serum beta-hCG (serial when the location is uncertain), blood group and Rh status, full blood count.

**Imaging**
Transvaginal ultrasound to confirm an intrauterine pregnancy, fetal heartbeat and retained tissue. Criteria for diagnosing a non-viable pregnancy are strict, and repeat scans are used when results are borderline.

## Differential diagnosis

- Ectopic pregnancy
- Implantation bleeding
- Molar pregnancy
- Cervical lesions or cervicitis
- Subchorionic haematoma

## Goal of treatment

Ensure the uterus empties safely, prevent haemorrhage, infection and Rh alloimmunisation, and support the woman emotionally.

## Treatment

**Conservative**
Expectant management: waiting for the tissue to pass naturally, with a follow-up check.

**Medical**
Medical management with a prostaglandin analogue (misoprostol), alone or after an antiprogestogen (mifepristone).

**Procedure**
Uterine aspiration (manual or electric vacuum) when bleeding is heavy, infection is present or the woman prefers it.

**Medical**
Anti-D immunoglobulin for Rh-negative women, according to local guidelines; antibiotics for septic miscarriage.

**Conservative**
Respectful counselling and emotional support, and referral for assessment after recurrent losses.

## Drugs for this condition

- [Oxytocin](https://durgical.com/en/pharmacology/oxytocin/)
- [Misoprostol](https://durgical.com/en/pharmacology/misoprostol/)
- [Mifepristone](https://durgical.com/en/pharmacology/mifepristone/)

## Complications

- Haemorrhage
- Infection (septic miscarriage)
- Retained tissue
- Intrauterine adhesions after instrumentation
- Rh alloimmunisation
- Grief, anxiety and depression

## Prognosis

After one miscarriage most women go on to have a successful pregnancy. The chance of another loss rises with maternal age and the number of previous losses; after recurrent losses a cause is looked for.

## Prevention

- Control of diabetes and thyroid disease before pregnancy
- Avoiding tobacco, alcohol and drugs
- Most miscarriages cannot be prevented

## Test yourself

Think of the answer, then tap the question to see it.

## What is the most common cause of first-trimester miscarriage?

Chromosomal abnormalities of the embryo.

## How is a threatened miscarriage distinguished from an inevitable one?

In a threatened miscarriage the cervix is closed and the pregnancy viable; in an inevitable one the cervix is open.

## What is a missed miscarriage?

A non-viable pregnancy that stays in the uterus with a closed cervix, often without symptoms.

## Why is Rh status checked in a woman with miscarriage?

Rh-negative women may receive anti-D immunoglobulin to prevent alloimmunisation, according to local guidelines.

## Which diagnosis must be excluded in early pregnancy bleeding with no intrauterine pregnancy on ultrasound?

Ectopic pregnancy.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/miscarriage/)

## Related conditions

- [Ectopic pregnancy](https://durgical.com/en/conditions/ectopic-pregnancy/)
- [Molar pregnancy (hydatidiform mole)](https://durgical.com/en/conditions/molar-pregnancy/)
- [Uterine fibroids (leiomyomas)](https://durgical.com/en/conditions/uterine-fibroids/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Early Pregnancy Loss (Spontaneous Abortion)](https://www.ncbi.nlm.nih.gov/books/NBK560521/) (StatPearls (NCBI Bookshelf), 2023).

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Source: https://durgical.com/en/conditions/miscarriage/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/miscarriage/