A false miscarriage, also known as a missed or silent miscarriage, occurs when a fetus dies in the early stages of pregnancy but the body does not recognize it. This results in the continuation of pregnancy symptoms and no vaginal bleeding or cramping. A false miscarriage is usually detected during a routine ultrasound exam and confirmed by additional testing.
What are the causes of a false miscarriage?
There are several possible causes of a false miscarriage:
- Chromosomal abnormalities – The most common cause is chromosomal abnormalities in the fetus, usually arising from the egg or sperm at conception.
- Hormonal problems – Issues with progesterone or human chorionic gonadotropin (hCG) hormones can impair fetal development.
- Uterine abnormalities – Abnormalities in the structure or shape of the uterus can prevent proper implantation.
- Luteal phase defect – Improper development of the Corpus Luteum after ovulation can lead to low progesterone.
- Thrombophilias – Blood clotting disorders like Factor V Leiden increase the risk.
- Autoimmune disorders – Diseases like antiphospholipid syndrome cause blood clots in the placenta.
- Uncontrolled diabetes – Poorly controlled blood sugar levels are toxic to the fetus.
In many cases, the exact cause remains unknown even after testing.
What are the symptoms of a false miscarriage?
The main symptom of a false miscarriage is a lack of typical miscarriage symptoms. There is:
- No vaginal bleeding
- No abdominal cramping or pain
- No tissue passing from the vagina
Pregnancy symptoms like nausea, fatigue, and breast tenderness often continue normally. Some women may notice a lightening of symptoms, but they do not disappear completely.
How is a false miscarriage diagnosed?
False miscarriages are most often discovered during routine first trimester ultrasounds when no fetal heart activity is detected. Other diagnostic tests include:
- Pelvic exam – The provider checks for any bleeding, dilation of the cervix, or passage of tissue.
- Ultrasound – Transvaginal ultrasound can confirm the absence of fetal heart tones.
- Blood tests – Falling hCG levels can indicate a nonviable pregnancy. Progesterone levels may also be checked.
If ultrasound and blood tests indicate a miscarriage but symptoms continue, a dilation and curettage (D&C) procedure may be done to remove any remaining tissue.
What are the treatment options for a false miscarriage?
Unfortunately, once a miscarriage is diagnosed there is no way to save the nonviable pregnancy. Management options include:
- Expectant management – Allows the miscarriage to complete naturally over days to weeks. Ultrasound monitoring tracks the passing of tissue.
- Medication – Drugs like misoprostol help expel the tissue, shortening the process.
- D&C procedure – Surgically removes any remaining pregnancy tissue under anesthesia.
Most women can attempt natural passing or medication first. D&C is an option if the process stalls or is incomplete.
What are the potential complications?
Complications are uncommon with a false miscarriage but can include:
- Hemorrhage – Heavy bleeding from incomplete passing of tissue.
- Infection – Bacteria entering the open cervix can cause endometritis or sepsis.
- Ashnerman’s syndrome – Scarring of the uterine lining after D&C, which can later cause infertility.
- Emotional distress – Depression, anxiety, PTSD, and grief at the loss of pregnancy.
Seeking prompt care if bleeding is excessive can reduce the risk of physical complications. Emotional support resources can help cope with the grief.
Can future miscarriages be prevented after a false miscarriage?
Testing can sometimes identify causes that are treatable:
- Hormonal problems may be corrected with supplements.
- Blood thinners can treat clotting disorders.
- Surgery can fix some uterine abnormalities.
- Tight blood sugar control helps for diabetes.
- IVF with preimplantation screening can identify abnormal embryos.
Other steps to reduce recurrent miscarriage risk include:
- Avoiding harmful exposures at work and home.
- Starting prenatal vitamins with folic acid before conception.
- Avoiding smoking, alcohol, and recreational drugs.
- Maintaining a healthy body weight.
There are still no guarantees, but many couples go on to have a successful pregnancy after a false miscarriage.
What is the outlook for future pregnancies after a false miscarriage?
The overall outlook for future pregnancies is generally good after a single false miscarriage. Some statistics on prognosis include:
- 75% of women will have a successful next pregnancy.
- 5% risk of repeat false miscarriage.
- 20-35% lifetime risk of another miscarriage overall.
- Less than 5% chance of 2 or more consecutive miscarriages.
Women over 35 or with multiple prior losses have lower success rates. Testing can identify any underlying causes impacting future outcomes.
When is it safe to try conceiving again after a false miscarriage?
Most experts recommend waiting until after one normal menstrual cycle to conceive again. Reasons to wait include:
- Allows time for hCG levels to return to zero.
- Ensures the uterus has healed from any procedures.
- Allows emotional recovery from the loss.
- Enables testing to identify potential causes.
- Gives time to correct any correctable risks.
There is no medical need to wait longer than one cycle. Women over 35 may wish to try again sooner due to lower fertility.
What support options are available after a false miscarriage?
Coping with the grief of a false miscarriage can be helped by:
- Talking to friends and family – Sharing feelings and getting support.
- Joining a support group – Online and in-person groups to not feel alone.
- Seeing a therapist – Working through the emotional trauma.
- Focusing on self-care – Getting rest, eating well, exercising.
- Planning a memorial – Holding a service or planting a tree to honor the loss.
Partners, family, friends, faith communities, and health providers can offer resources to help women cope and move forward.
Conclusion
A false miscarriage is a tragic event where a fetus dies but the mother’s body fails to recognize it. While uncommon, it is important to diagnose the loss through ultrasound and bloodwork once pregnancy symptoms persist without evidence of tissue passing. Expectant, medical, or surgical management can then help clear the uterus. Testing may reveal preventable causes of loss to improve future outcomes. With time and support, most couples can still go on to a successful subsequent pregnancy after a false miscarriage.