What is a missed miscarriage?

How does a missed or silent miscarriage differ from other miscarriages? Why does it happen – and what happens when it's diagnosed? We explain – with expert help from Dr Philippa Kaye

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Missed miscarriage or ‘silent miscarriage’ is an umbrella term for any miscarriage that happens with no symptoms straightaway. You often only find out your baby has died or has not developed when you go for a scan (either privately or on the NHS).

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Because there’s no warning that anything’s wrong and, often, your pregnancy hormones can remain high (making you feel pregnant and registering positive pregnancy tests), a missed miscarriage can – obviously – come as a complete shock.

“A missed miscarriage is essentially a baby loss where there has been no physical miscarriage and no signs that a miscarriage is about to happen – no bleeding, for example,” says our expert family GP Dr Philippa Kaye. “So it is picked up later, either when bleeding does start or, more often, at the 12-week dating scan.” 

What causes missed miscarriage?

No one really knows. A 1996 study at Harris Birthright Research Centre For Fetal Medicine in Kings College Hospital Medical School, London, suggests it happen in about 3 per cent of all miscarriages but scientists are not at all clear why, sometimes, when a baby dies, the actual physical miscarriage can take so much longer – even weeks longer – to happen than is usually the case.

“Why some people present with bleeding straightaway and others do not is simply not known,” says Philippa.

What is known is that there are some types of pregnancy loss, such as ‘blighted ovum’ (where the fertilised egg implants in the your womb but doesn’t then develop any further) where your levels of pregnancy hormones don’t decrease straightaway (in the case of blighted ovum because your placenta still continues to grow for a while afterwards). It’s possible that these continuing high levels may delay the onset of physical miscarriage.

What happens if I’m told it’s a missed miscarriage?

If you hear the news at a scan, it may be a definite diagnosis – or you may have to come back for another scan before anything can be confirmed for sure. This can be 

“Once the diagnosis is made, it’s treated the same way as other miscarriage,” says Dr Philippa, “either with a wait-and-see approach or, if bleeding hasn’t started after 7 to 14 days, then other options are more likely. 

“These other treatments include medical management – with medication to speed up the miscarriage process – or surgical management, if you’re bleeding heavily or if the medication (or just waiting) hasn’t worked.”

Your feelings after a missed miscarriage

Miscarriage, in and of itself, can – of course – be hugely upsetting however it happens but, with a missed miscarriage, you have to deal with the sudden shock, too.

And maybe the realisation that your baby may have died some time ago.

And that can be very difficult – especially if you find out at your first scan, when you might have been so excited about seeing your baby, getting pics and announcing your pregnancy.

Lone woman sitting on the bed looking out at the window in the morning

“Missed miscarriage can be extremely upsetting, and many women say the idea that they thought everything was fine, when it wasn’t, was very difficult to handle,” says Dr Philippa. 

That’s definitely how tracey4 on our forum felt. She posted: “I had my first scan last Wednesday night and was told there was no heartbeat. 

I noticed on the screen that the baby had died at 8 weeks and 2 days. I am totally devastated... I can't stop crying and, no matter what anyone says, still feel like it's my fault.

But you must know that it’s absolutely not your fault.

And neither is it your fault that you didn’t know what was happening.

You couldn’t have stopped it happening. And there’s no way you could have known – except by having that scan.

About our expert GP Philippa Kaye

Dr Philippa Kaye works as a GP in both NHS and private practice. She attended Downing College, Cambridge, then took medical studies at Guy’s, King’s and St Thomas’s medical schools in London, training in paediatrics, gynaecology, care of the elderly, acute medicine, psychiatry and general practice. Dr Philippa has also written a number of books, including ones on child health, diabetes in childhood and adolescence. She is a mum of 3.

Pics: Getty

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