Miscarriage Signs and Risk by Week

If you are reading this while bleeding or worried, we hope it brings some clarity. Bleeding in early pregnancy does not always mean a miscarriage, and many pregnancies with spotting continue. This page explains the signs, how the risk changes week by week, when to get urgent care, and what happens next if a loss is confirmed.

What are the signs of a miscarriage?

Bleeding is the most common sign of miscarriage. ACOG advises calling your ob-gyn if you have any of these:¹

• vaginal spotting or bleeding, with or without pain
• a gush of fluid from the vagina, even without pain or bleeding
• passing tissue from the vagina

Cramping like a period often comes with the bleeding. If your bleeding is heavy or comes with pain like menstrual cramps, ACOG advises contacting your ob-gyn right away.¹

Two things are important to know. First, about half of women who have a miscarriage do not have any bleeding beforehand; some losses are found at a routine scan.² Second, a small amount of bleeding early in pregnancy is common and does not necessarily mean a miscarriage.¹ Bleeding happens in 15 to 25 in 100 first-trimester pregnancies.²

Spotting vs bleeding that is more concerning

In a study of 4,510 pregnant women, spotting and light bleeding were not linked to a higher risk of miscarriage, especially episodes lasting only 1 or 2 days. Heavy bleeding was linked to about three times the risk, and most of that extra risk was in women who had heavy bleeding together with pain.⁶

One-sided pain or shoulder pain can be signs of an ectopic pregnancy, which grows outside the uterus and can cause internal bleeding.⁷

Miscarriage risk by week

Overall, early pregnancy loss happens in about 10 in 100 known pregnancies.¹ The risk is highest in the earliest weeks and falls as the pregnancy goes on.

After a normal visit with a heartbeat

The clearest week-by-week numbers come from a study of 696 women with no symptoms who had a heartbeat seen on ultrasound at their first prenatal visit. Their risk of later miscarriage was:³

Across the whole group, the risk was 1.6%. The authors note these figures apply to people without symptoms, and that higher caution is needed for people with higher background risk, such as older age or fertility treatment.³

Across weeks 5 to 20

A systematic review combining four studies found weekly miscarriage rates as high as more than 20 per 1,000 women-weeks in the weeks before 13 weeks. By week 14, rates in all four studies were similar and had fallen below 10 per 1,000, and they fell further through week 20. The cumulative risk from week 5 to week 20 ranged from 11% to 22% across studies.⁴

By age

Age has the biggest effect. In 421,201 pregnancies in Norway, the risk of miscarriage was lowest at ages 25 to 29 (10%) and rose quickly after 30, reaching 53% at 45 and over.⁵ ACOG notes that for women over 40, about 1 in 3 pregnancies end in miscarriage, most because of a chromosome difference.¹ The same Norwegian study found the risk was higher after previous miscarriages.⁵

These are averages. They cannot predict what will happen in one pregnancy, and most pregnancies at every age continue.

Why miscarriage happens

About half of early miscarriages happen when the embryo does not develop properly, often because of an abnormal number of chromosomes.¹ ACOG is clear that, in almost every case, miscarriage is not the pregnant person's fault: working, exercising, stress, arguments, having sex, having used birth control pills, and morning sickness do not cause miscarriage.¹ A recent fall or shock is also very unlikely to be the cause, even though it may feel connected.¹

How a miscarriage is confirmed

If you have bleeding or cramping, your clinician may do an ultrasound to check whether the pregnancy is growing and, if far enough along, whether there is cardiac activity. Very early on, not seeing cardiac activity may simply mean it is too early to see. A blood test for hCG may be repeated: a low or falling level can mean a loss. It can take several scans and blood tests to be sure.¹

What happens next

If a miscarriage is confirmed, ACOG describes these options, and the choice depends on your health, how far along the pregnancy was and what feels right for you:¹

• Waiting (expectant management): if there are no signs of infection, the tissue often passes on its own, usually within 2 weeks, sometimes longer.
• Medication that helps the uterus pass the tissue.
• A procedure: vacuum aspiration, often done in the office, or dilation and curettage (D&C). Surgery is recommended if there are signs of infection or heavy bleeding.

With waiting or medication, expect bleeding, sometimes heavy, with cramps; tissue may look like a blood clot with grey-white material.¹ If you are Rh negative and 12 weeks or more pregnant, a shot of Rh immunoglobulin is recommended; under 12 weeks, ask your ob-gyn whether you need it.¹

Recovery

To prevent infection, ACOG advises not putting anything in the vagina, including tampons and sex, for 1 to 2 weeks, and a follow-up visit a few weeks later. Call right away for heavy bleeding, fever, chills or severe pain.¹

Grief, support and trying again

Losing a pregnancy can bring deep sadness, and emotional healing often takes longer than physical healing; partners may grieve differently.¹ It is normal to need time and support. Our pregnancy loss support page lists organizations, counseling options and ways to get through the weeks after a loss.

Most people who have an early pregnancy loss go on to have successful pregnancies, and repeated miscarriages are rare. If you have had two or more, testing can look for a cause.¹ You can get pregnant again as soon as 2 weeks after an early miscarriage, but there is no rush: some people wait for one period, and some wait longer to feel ready.¹

For a very early loss confirmed only by a pregnancy test, see chemical pregnancy. For what is normal in the first weeks, see early pregnancy symptoms, or return to the Pregnant hub.