Signs and Symptoms of Miscarriage: What’s Normal and When to Get Help

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One of the hardest parts of early pregnancy is learning to balance excitement with worry. Every cramp, twinge, or spot of blood can make you wonder if something is wrong. The truth is that many early pregnancy symptoms are normal — but some may signal a miscarriage.

This article will walk you through:

• The most common signs and symptoms of miscarriage
• Which symptoms are often normal in early pregnancy and don’t mean you’re miscarrying
• When to call a doctor or midwife right away
• How miscarriage is diagnosed and what to expect
• The emotional side of waiting, worrying, or experiencing a loss

My goal is not to make you more worried, but to help you feel informed and prepared. Knowing what is normal and what isn’t can give you a little more confidence in these uncertain weeks.

Understanding Miscarriage Symptoms

Not every miscarriage looks the same. Some happen suddenly with heavy bleeding and pain. Others may have very few signs and are only discovered at a routine ultrasound. Symptoms can also vary depending on when the miscarriage happens – if it is very early (before 6 weeks) or later in the first trimester, or after 12 weeks.

Possible Signs of Miscarriage

Here are the most common symptoms that may signal a miscarriage:

Vaginal bleeding

Bleeding is the most frequent sign of miscarriage, and it can vary from light spotting to heavy bleeding with clots.

• Light spotting can also be normal in early pregnancy, but bleeding that becomes heavier — especially if it soaks a pad in an hour or contains clots or tissue — should be checked urgently.
• According to the NHS, about 20% of women experience some bleeding in the first trimester, but not all go on to miscarry.

Cramping and abdominal pain

Cramping or dull aching in the lower abdomen or back can accompany bleeding in miscarriage. The pain may be mild and period-like, or later in first trimester, it can be stronger and more wave-like.

• Mild, occasional cramps alone aren’t unusual in early pregnancy as the uterus stretches.
• Severe or persistent pain, especially with bleeding, is a red flag.

Passing tissue or fluid

Some women notice the passage of tissue or grayish material from the vagina. This usually confirms that a miscarriage is occurring.

• Clear or pinkish watery fluid can also be a sign if it comes with bleeding or pain.
• In later pregnancy, fluid loss could suggest rupture of membranes and requires urgent care.

Loss of pregnancy symptoms

A sudden loss of symptoms such as nausea, breast tenderness, or fatigue may be noticed by some women.

• This can happen naturally as hormone levels stabilize after the first trimester, but if it happens very early and especially with bleeding, it may point to miscarriage.
• ACOG notes that this alone is not diagnostic — only an ultrasound or hormone testing can confirm what is happening.

Back pain or pelvic pressure

Some women report lower back pain or a sense of pelvic pressure when miscarriage begins. This is more likely when the miscarriage occurs later in the first or early second trimester.

Note: Having one of these symptoms doesn’t always mean you are miscarrying. Many women spot or cramp in early pregnancy and still carry healthy babies. But heavier bleeding, severe pain, or passage of tissue always warrant medical evaluation.

What Is Normal in Early Pregnancy (and Often Confused With Miscarriage)

One of the hardest parts of early pregnancy is that many normal changes can look or feel a lot like warning signs. Here are some common experiences that are usually normal and don’t necessarily mean you are miscarrying:

Light spotting

A small amount of spotting is common, especially in the first weeks. It may happen:

• Around the time of implantation (sometimes called implantation bleeding)
• After sex, since the cervix is more sensitive during pregnancy
• After a vaginal exam or ultrasound

Light pink or brown discharge is usually not a cause for alarm. The NHS notes that spotting alone, without pain, is generally not a sign of miscarriage.

Mild cramping

Your uterus is growing and stretching from the very beginning. Many women feel mild twinges or period-like cramps in early pregnancy.

• As long as cramps are mild, occasional, and not worsening, they are usually normal.
• Severe pain, especially with bleeding, is a reason to call your doctor or midwife.

Fluctuating symptoms

Pregnancy symptoms such as tender breasts, nausea, or exhaustion are all caused by hormones. These can naturally come and go, or feel stronger some days than others.

• It’s not unusual for nausea to ease after week 9–10, when hormone levels start to stabilize.
• A complete and sudden disappearance of symptoms, especially if paired with bleeding, should be checked, but changes alone don’t confirm miscarriage.

Note: Not every twinge, spot, or symptom change means the worst. But if you are worried, reaching out to your doctor or midwife can give you peace of mind — and sometimes an early scan is the best reassurance of all.

When to Seek Medical Advice

Go to emergency care right away (ER/A&E or call 999/911) if you have:

• Heavy bleeding that soaks through pads quickly (for example, more than two pads per hour for two hours in a row)
• Large clots or tissue with bleeding so heavy you feel faint or unwell
• Severe abdominal pain, strong one-sided pain, or shoulder-tip pain
• Feeling faint, dizzy, or collapsing
• Fever and chills combined with bleeding or pain
• These symptoms may signal miscarriage or ectopic pregnancy, which can be life-threatening if untreated.

Both ACOG and the NHS list heavy bleeding, severe pain, and fainting/dizziness as reasons to seek immediate care. NICE also highlights shoulder-tip pain as a warning sign of ectopic pregnancy.

Call your doctor or midwife the same day if you have:

• Bleeding that is more than spotting, or bleeding with clots or tissue
• Persistent or moderate cramping that doesn’t ease with rest
• Fever (100.4°F / 38°C or above) without another cause
• Ongoing one-sided pelvic pain

In these cases, you may need an ultrasound or blood tests to check on the pregnancy and to make sure it isn’t ectopic. Many women are referred to an Early Pregnancy Unit (EPU) in the UK or an early pregnancy clinic elsewhere. Both NICE and ACOG recommend same-day evaluation for women with these symptoms.

Call your doctor or midwife (within 24 hours / next business day) if you notice:

• Light spotting only
• Mild cramps that are not getting worse
• A sudden change in pregnancy symptoms (such as nausea easing or breasts feeling less tender)

These lighter symptoms don’t always mean a miscarriage is happening, but they’re worth discussing. Your care team can decide if you need a reassurance scan, follow-up blood work, or simply monitoring.

If you are Rh-negative, your doctor or midwife may also talk with you about whether anti-D (Rh immunoglobulin) is recommended. Most current guidelines (ACOG, NICE, NHS) state that anti-D is not needed for light spotting or threatened miscarriage before 12 weeks. It may be offered if bleeding is heavier, if there is an ectopic pregnancy, or if a surgical procedure (like a D&C) is required. Policies can differ slightly by country, so always follow your local advice.

Both ACOG and the NHS note that mild spotting or cramping often turn out to be harmless, but still encourage women to call so they can be advised on next steps and reassured if needed.

Note: If you are unsure, it’s always better to call. Many doctors and midwives would rather hear from you early than have you sitting at home worried. Even if everything turns out fine, a little reassurance can make a big difference.

How Miscarriage Is Diagnosed

Even when symptoms suggest a miscarriage, only a medical assessment can confirm what is happening. Diagnosis usually involves a combination of ultrasound scans and blood tests.

Ultrasound

The most important tool is an ultrasound scan, which shows whether the pregnancy is developing as expected. Depending on how far along you are, the scan may look for:

• A gestational sac (normally visible by about 5 weeks)
• A yolk sac (usually visible by 5½ weeks)
• An embryo with a heartbeat (usually visible by 6–7 weeks)

If these aren’t seen when expected, it doesn’t always mean miscarriage. Sometimes dates are off by a few days. For this reason, doctors often recommend a repeat scan in 7–10 days before confirming a miscarriage.
A study published in the New England Journal of Medicine (Doubilet et al., 2013) updated the criteria for diagnosing nonviable pregnancy by ultrasound. They stressed that miscarriage should never be diagnosed on a single uncertain scan, to avoid the risk of ending a viable pregnancy.

Blood tests (hCG levels)

Blood tests measuring human chorionic gonadotropin (hCG) can help, especially very early in pregnancy.
In a normal pregnancy, hCG roughly doubles every 48–72 hours in the first weeks.
If levels are rising slowly or falling, it may indicate a miscarriage or an ectopic pregnancy.
However, hCG patterns can vary, so these tests are usually combined with ultrasound results for a clearer picture.

Physical exam

In some cases, a doctor or midwife may also do a pelvic exam to check whether the cervix is open or closed. An open cervix with bleeding often means a miscarriage is in progress.

Note: A single test is rarely enough to diagnose miscarriage with certainty. Most guidelines (ACOG, NHS, NICE) recommend combining scan findings, blood work, and sometimes repeat assessments before making a final diagnosis. This waiting period can be very stressful, but it is done to ensure that a viable pregnancy is never mistakenly labeled as a loss.

Emotional Aspects and Support

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The physical process of miscarriage is only part of the story. For many women — and their partners — the emotional impact is just as significant. Worrying that you might be miscarrying, waiting for test results, or experiencing a confirmed loss can bring feelings of fear, sadness, guilt, or even numbness. All of these reactions are normal.

The stress of uncertainty

One of the hardest parts is the waiting: waiting for symptoms to settle, waiting for blood results, or waiting for a repeat scan. Research shows that this period of “not knowing” can be very stressful. Knowing that it’s standard practice to repeat scans before making a diagnosis may help you understand why the wait is necessary — but it doesn’t make it easy.

If you are going through a loss

• Miscarriage is not your fault. Most miscarriages are caused by chromosomal problems that are completely outside your control.
• Allow yourself to grieve in your own way. Some women feel ready to try again quickly, while others need more time. Both are okay.
• Partners can grieve differently — some may show their feelings openly, others more privately. That doesn’t mean they aren’t affected.

Finding support

• In the US, groups like Share Pregnancy & Infant Loss Support and March of Dimes offer resources.
• In the UK, Tommy’s and The Miscarriage Association provide helplines, online communities, and practical advice.
• There are, of course, a lot of other online communities, too, including Facebook groups, Reddit, and many more. 
• Talking with a trusted friend, midwife, or counselor can also make a big difference.
• You can also read the stories shared in the comment section of our article on miscarriage statistics.

Remember: Most pregnancies are healthy, and even after miscarriage, the majority of women go on to have successful pregnancies. If you are worried or grieving, you are not alone — support is available.

Read Next

• Getting Pregnant After Miscarriage: Timing and Tips
• What Causes Miscarriage? Facts, Myths, and What You Can (and Can’t) Control
• Miscarriage Statistics by Week (Causes, Risk Factors, Weekly Rates)
• Can Stress Cause Miscarriage? Yes, Maybe, according to Research

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Paula Dennholt

Paula Dennholt founded Easy Baby Life in 2006 and has been a passionate parenting and pregnancy writer since then. Her parenting approach and writing are based on studies in cognitive-behavioral models and therapy for children and her experience as a mother and stepmother. Life as a parent has convinced her of how crucial it is to put relationships before rules. She strongly believes in positive parenting and a science-based approach.

Paula cooperates with a team of pediatricians who assist in reviewing and writing articles.