Missed (silent) Miscarriage

A missed miscarriage (or silent miscarriage) is a type of pregnancy loss where the baby has stopped developing, but the body has not yet passed the pregnancy. This usually happens in early pregnancy (before 20 weeks).¹ The cervix stays closed and pregnancy hormones may continue to be high, so there may be no bleeding or cramping.² It is usually discovered during an ultrasound which will confirm a non-viable pregnancy with no bleeding.^2,3

Many women and birthing people will still feel pregnant with ongoing pregnancy symptoms² such as breast tenderness, nausea, and/or tiredness,⁴ so it can be a very distressing experience and may come as a complete shock.²

A missed miscarriage is usually discovered during an ultrasound scan, typically between 12–20 weeks, but can be earlier in some cases.

These scans may be:

• Routine dating scan (~12 weeks)
• Anomaly scan (~20 weeks)
• A scan arranged due to a history of previous miscarriage, or other concerns
• Private scans between routine ones provided by your healthcare provider

When a missed (or silent) miscarriage is confirmed on an ultrasound scan,^5–7 the sonographer may see:²

• A pregnancy sac and/or an embryo, but with no detectable heartbeat
• A pregnancy sac that is too small for that stage of pregnancy
• An empty sac with no visible embryo

You may also hear the terms foetal pole or foetus depending on the stage of pregnancy.

If a gestational sac is visible but no embryo is seen, it is usually called an anembryonic pregnancy. This is also a type of early pregnancy loss.²

No visible sac (pregnancy test positive, no sac on scan) is often termed a “pregnancy of unknown location (PUL)” until follow-up scans or hCG trends clarify if it is intrauterine (within the uterus) or ectopic.⁷

There are multiple ways to manage a missed miscarriage, which does require some difficult conversations and decisions. This process can be overwhelming, but it can also give back some control on how you manage the pregnancy loss. There is no obligation to make the decision immediately. A decision should be made only once you feel fully informed of all your options on the treatment, management, and support available to you.

There may be feelings of guilt, or you may be searching for reasons for why this has happened, but a missed miscarriage is something that occurs by chance and is beyond anyone’s control.

A missed miscarriage happens when a pregnancy stops developing but the body hasn’t passed the pregnancy. The most common cause is a chromosomal problem (in over 50% of cases), which prevents the pregnancy from developing properly.⁸ Other possible causes include issues with the uterus (like fibroids or unusual shape), hormone problems (such as thyroid issues or low progesterone), immune system difficulties, or certain infections.⁹ However, in many cases, the exact reason is unknown,² which may be hard to process and may affect how you feel about getting pregnant again.