Miscarriage - threatened

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Definition

A threatened miscarriage is a condition that indicates the potential for a miscarriage or early pregnancy loss. It might take place before the 20th week of pregnancy.

Alternative Names

Threatened miscarriage; Threatened spontaneous abortion; Abortion - threatened; Threatened abortion; Early pregnancy loss; Spontaneous abortion 

Causes

Some pregnant women have some vaginal bleeding during the first 3 months of pregnancy. Bleeding may occur with or without abdominal cramps. When the symptoms indicate a miscarriage is possible, the condition is called a "threatened abortion." (This refers to a natural event that is not due to a medical or surgical abortion.)

Miscarriage is common. Small falls, injuries or stress during the first trimester of pregnancy can cause threatened miscarriage. It occurs in almost one half of all pregnancies. The chance of miscarriage is higher in older women. About one half of women who have bleeding in the first trimester will have a miscarriage.

Symptoms

Symptoms of a threatened miscarriage include:

  • Vaginal bleeding during the first 20 weeks of pregnancy (last menstrual period was less than 20 weeks ago). Vaginal bleeding occurs in almost all threatened miscarriages.
  • Abdominal cramps may also occur. If abdominal cramps occur in the absence of significant bleeding, consult your health care provider to check for other problems besides threatened miscarriage.

Note: During a miscarriage, low back pain or abdominal pain (dull to sharp, constant to intermittent) can occur. Tissue or clot-like material may pass from the vagina.

Exams and Tests

Your provider may perform an abdominal or vaginal ultrasound to check the baby's development and heartbeat, and the amount of bleeding. A pelvic exam may also be done to check your cervix.

Blood tests done may include:

Treatment

Apart from controlling the blood loss, you may not need any particular treatment. If you are Rh Negative, then you may be given immune globulin. You may be told to avoid or restrict some activities. Not having sexual intercourse is often recommended until the warning signs have disappeared. 

Outlook (Prognosis)

Most women with a threatened miscarriage go on to have a normal pregnancy.

Women who have had two or more miscarriages in a row are more likely than other women to miscarry again.

Possible Complications

Complications may include:

  • Anemia from moderate to heavy blood loss, which may require a blood transfusion.
  • Infection.
  • Miscarriage.
  • The health care provider will want to ensure that the symptoms are not due to an ectopic pregnancy. This is a potentially life-threatening complication.

When to Contact a Medical Professional

If you know you are (or are likely to be) pregnant and you have any symptoms of threatened miscarriage, contact your prenatal provider right away.

Prevention

Most miscarriages cannot be prevented. The most common cause of a miscarriage is a random genetic abnormality in the developing pregnancy. If you have two or more repeated miscarriages, you should consult a specialist to look for an underlying condition that is causing the problem. Women who get prenatal care have better pregnancy outcomes for themselves and their babies. 

A healthy pregnancy is more likely when you avoid things that are harmful to your pregnancy, such as:

  • Alcohol
  • Infectious diseases
  • High caffeine intake
  • Recreational drugs
  • X-rays

Taking a prenatal vitamin or folic acid supplement before becoming pregnant and throughout your pregnancy can lower your chance of miscarriage and improve the chance of delivering a healthy baby.

It is better to treat health problems before you get pregnant than to wait until you are already pregnant. Miscarriages caused by diseases that affect your whole body, such as high blood pressure, are rare. But you can prevent these miscarriages by detecting and treating the disease before becoming pregnant.

Other factors that can increase your risk for miscarriage include:

  • Obesity
  • Thyroid problems
  • Uncontrolled diabetes

Images

Early pregnancy
Threatened miscarriage

References

Keyhan S, Muasher L, Muasher SJ. Spontaneous abortion and recurrent pregnancy loss: etiology, diagnosis, treatment. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 16.

Richards DS. Obstetric ultrasound: imaging, dating, growth, and anomaly. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 9.

Salhi BA, Nagrani S. Acute complications of pregnancy. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 178.

Review Date: 
12/2/2020
Reviewed By: 
LaQuita Martinez, MD, Department of Obstetrics and Gynecology, Emory Johns Creek Hospital, Alpharetta, GA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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