What is a missed miscarriage and how is it managed?

Miscarriage is a topic that affects many women but remains taboo for them, their partners, and their loved ones.

After doing some research and asking women around us, we realized that many of them don't know exactly what it is: what is the difference between a miscarriage and a missed miscarriage? What is the cause? Can you get pregnant after a missed miscarriage?

Yet, every year in France, 200,000 women are affected by missed miscarriages in the first trimester. So, we've put together a summary article to answer all these questions and finally open up the dialogue.

What you need to know about missed miscarriage

What is the difference between a missed miscarriage and a miscarriage?

A missed miscarriage refers to the premature cessation of a pregnancy during the first 5 months: development stops naturally. It is also called a "miscarriage" or "spontaneous abortion," which refers to exactly the same phenomenon.

Miscarriages are quite common, affecting 15% of pregnancies. That's why it's essential to talk about it! Moreover, suspected miscarriage in the first trimester of pregnancy is the most frequent cause of consultation in gynecological emergencies (CHU de Rennes study).

Miscarriages are common, but they should not be trivialized. Some women find it difficult to project themselves back into motherhood after such an event; they feel guilty, alone, and misunderstood. Understanding miscarriages is the first step to reconciling with one's body and envisioning the future again, with or without a baby.

What are the different types of missed miscarriage?

There are different types of miscarriages depending on when the pregnancy stops.

• Early missed miscarriage, before 14 weeks of amenorrhea (WA). Some may even go unnoticed if they are very early. They can even be confused with menstruation.

• Late missed miscarriage, between 14 WA and 22 WA. This type of miscarriage is rarer and affects less than 1% of pregnancies.

Whether it's a very early, early, or late missed miscarriage, the symptoms are the same: abnormal bleeding and more or less intense lower abdominal pain, somewhat like contractions.

The 22 WA barrier doesn't come from nowhere: it was set by the WHO (World Health Organization) as the gestational age at which the fetus is viable. Beyond that, it is no longer considered a miscarriage but a premature birth or an intrauterine fetal death (IUFD) if delivery does not occur.

How to explain a missed miscarriage?

It is sometimes difficult to find the exact cause of a missed miscarriage. Some women want to investigate to understand exactly what happened, while others do not feel the need to know.

Miscarriages related to the embryo

In nearly 60% of cases, a missed miscarriage is directly linked to a problem with the embryo, especially if the miscarriage occurs early, in the first trimester of pregnancy.

This can be, for example, a chromosomal abnormality or a problem with embryonic development (nervous system, heart, or lungs). It's impossible to predict in advance, genetic lottery plays its part, even if it's very unfair...

If you've already looked into miscarriage a bit, you've probably heard of the blighted ovum. In this specific case, fertilization did occur, so your body acts as if you were pregnant: membranes and placenta develop, your pregnancy test is positive, and you feel the first symptoms, but in reality, no embryo has managed to form. A blighted ovum is actually a very early missed miscarriage.

When the mother's health is involved

Other times, it is the mother's health that can explain a premature cessation of pregnancy. You are particularly exposed to the risk of miscarriage if you suffer from:

• diabetes,

• thyroid disease,

• coagulation disorders,

• gynecological disease (e.g., endometriosis or PCOS),

• celiac disease (gluten allergy).

Age is also an important factor to consider: it is not a disease at all, but it is true that the miscarriage rate increases with age.

• 10% before 30 years old,

• 20% between 30 and 40,

• 53% at 45 years old and over.

Finally, as we always tend to blame women, we remind you that sperm quality also plays a role in the course of a pregnancy (Inserm).

External factors explaining a missed miscarriage

As you might expect, environmental factors and your lifestyle also play a role in everything related to fertility and pregnancy. Obstetrician-gynecologist Aparna Sridhar reminds us of the elements to monitor:

• alcohol consumption (the golden rule is zero alcohol during pregnancy),

• tobacco or drug use,

• infections (e.g., toxoplasmosis or rubella),

• inhalation of certain industrial chemicals,

• consumption of contraindicated medications,

• consumption of contraindicated plants (absinthe, mugwort, génépi, aloe, cascara, buckthorn, sage... the list is long)!

The ideal is to have a brief discussion with your doctor or gynecologist as soon as you know you are pregnant to find out exactly what good habits to adopt for the coming months. Of course, you may follow the recommendations to the letter and the pregnancy may not reach term: you are not responsible; be gentle with yourself and take care of your body.

Management and support for a missed miscarriage

There are different ways to manage a missed miscarriage. This depends on the embryo's level of maturity and how its development was interrupted.

1. The pregnancy has been completely expelled

In this first case, your body has done almost all the work by itself by expelling the embryonic tissues. Bleeding gradually decreases, day after day, without medical intervention. Your uterus slowly returns to its normal shape. If needed, you can take painkillers to relieve the discomfort of contractions in the first few days.

2. The pregnancy has not been completely expelled

In this second scenario, your body needs a little help. There are several solutions to evacuate the contents of the uterus:

1. Wait a few days for your body to naturally release the embryo. This natural method is certainly not very invasive, but some women find it difficult to be in a waiting position, knowing that the embryo is no longer alive.

2. Choose expulsion by medication. In this scenario, your medical team offers you medications (mifepristone and misoprostol) to induce uterine contractions and accelerate the release of the embryo. The treatment is generally taken at the hospital and then followed at home with painkillers. A week later, a follow-up ultrasound checks that the protocol has worked. Note, however, that this option is not accessible beyond 9 WA.

3. Opt for surgery. This last solution is possible if the medications have not worked or if you are more than 9 WA. The procedure is performed as an outpatient, under local or general anesthesia, and consists of aspirating the contents of the uterus. Everything is done to ensure that you do not feel any pain and that the procedure is as quick as possible.

Whatever option you choose, do not hesitate to seek psychological support beforehand and/or afterward. Once again, miscarriages should not be trivialized: some women cope poorly with the loss of an embryo and experience medical intervention as an intrusion.

Psychological support can help you to overcome guilt, address the topic of parenthood and intimacy in the couple, and give your partner a place in this stage of life. Do not isolate yourself; seek support and answers from qualified professionals and your loved ones.

We also recommend listening to testimonials from women who are experiencing or have experienced missed miscarriages. Ask your loved ones, friends, or listen to women's stories: the Bliss Stories podcast offers several episodes dedicated to this topic. An essential resource to feel less alone.

Can you get pregnant again after a missed miscarriage?

The answer is yes! You can even get pregnant quickly after a miscarriage, as early as the next cycle if there are no particular problems.

In general, the obstacle is more psychological than physical. Some women feel guilty after a miscarriage: they question their age, their lifestyle, and replay the last few weeks to know what they could have done better... After a missed miscarriage, it is normal to approach motherhood with a touch of apprehension.

“After a pregnancy loss, there is a disruption in the woman's gestational plans, thus questioning her reproductive capacity. Women with a history of fetal loss may wonder if they are capable of carrying a subsequent pregnancy to term or not, and this doubt may persist throughout their pregnancy. Despite the traumatic experience of this event, 80% of couples decide to conceive a new child shortly after within 18 months.” Jeanne Pedrono, The experience of miscarriages in women and the consequences for their future pregnancy plans, Human Medicine and Pathology, 2022.

In reality, recurrent miscarriages can happen but are rather rare. The French National Authority for Health (Haute Autorité de Santé) recommends a fertility assessment after 3 missed miscarriages.

After a miscarriage, give yourself time to reclaim your body, your femininity, and your intimacy. Rebuild the tenderness and complicity that unites you with your partner, and most importantly, trust yourself—you are capable of great things!