What Is a Threatened Miscarriage? Causes, Signs, and Treatment

Try not to panic—even if your doctors are alluding to a threatened miscarriage, that doesn’t mean you’ll lose your baby. This is a term used to describe a set of symptoms that require medical attention but that often resolve and give way to perfectly healthy pregnancies.

Let’s take a look at what a threatened miscarriage is and what you should do if you notice the telltale signs.

The term “threatened miscarriage” is often used when someone experiences bleeding or pain in the first 20 weeks of pregnancy, most frequently during the first trimester (the first 12 weeks).

While it’s not an official medical diagnosis, it’s a common way to describe a set of worrying pregnancy symptoms that could potentially lead to a miscarriage. Essentially, it signals that there may be a risk to your pregnancy, but that your doctor hasn’t determined yet how serious it is.

This is also sometimes referred to as a “threatened abortion,” an even more alarming term. While both sound scary, remember that they don’t necessarily mean you’ll actually miscarry. 1

What are the symptoms of a threatened miscarriage?

The main symptoms of a threatened miscarriage are: 1

• Vaginal bleeding: This can consist of either light spotting or heavier bleeding, which may or may not include small clots.
• Abdominal pain or cramping: This can be mild or intense, either like a dull ache or a sharp, stabbing pain. It may be generalized or confined to your lower back.

Some moms-to-be experience just one of those symptoms, while others have both at the same time. How long the bleeding or pain lasts varies from mom to mom and depends on what’s causing it in the first place. Make sure you discuss any bleeding or pain during pregnancy with your doctor.

What’s the difference between a threatened miscarriage and a miscarriage?

Just to reiterate one more time, unlike a true miscarriage, a threatened miscarriage doesn’t mean you’ve lost your baby. Approximately 50–70% of threatened miscarriages result in normal pregnancies.

Most of the time, if there’s a fetal heartbeat present and your cervix is closed, your pregnancy will continue successfully despite any bleeding. 1 2 Your baby’s heartbeat will start quite early, with cardiac activity potentially beginning in week 4 of your pregnancy, and your doctor may be able to detect it in week 6 or 7. After that, statistically, your odds of miscarrying drop significantly.

It can be hard to determine the exact cause of a threatened miscarriage. Pregnancy is complicated, and cramping and bleeding can indicate many things. However, common culprits include: 3

• Subchorionic hematoma: This is a small blood clot that forms between the uterine wall and the placenta. It’s a common cause of bleeding in early pregnancy, and while it can lead to complications, it also often resolves on its own.
• Implantation bleeding: This is a normal part of early pregnancy and happens when the fertilized egg attaches to the uterine lining. Implantation bleeding is typically pink or rust-colored and is relatively light (not enough to soak through a pad).
• Cervical issues: Inflammation of your vagina (vaginitis) or cervix (cervicitis) or developments like polyps or lesions can cause bleeding. 1
• Infection: Vaginal infections can sometimes cause bleeding and will generally be treated with antibiotics.
• Hormonal changes: Sometimes, early pregnancy bleeding is simply caused by your surging hormones and doesn’t indicate an underlying issue at all. 4

While some of these reasons for bleeding usually resolve on their own, it’s always best to get looked over by your doctor to determine the cause.

Ectopic pregnancy

In some cases, an embryo can attach somewhere outside the uterus, usually in the fallopian tube. This is known as an ectopic pregnancy. Without access to the blood necessary to grow, the embryo typically dies.

An ectopic pregnancy is one of the more serious causes of a threatened miscarriage. If the embryo isn’t removed, it could lead to a life-threatening hemorrhage. While your uterus can expel a miscarriage, an embryo that’s lodged elsewhere in the body may need to be managed with medication or removed through surgery. 5 6

Pregnancy of unknown location

If your doctor can’t see your pregnancy on an ultrasound, they may diagnose you with a pregnancy of unknown location (PUL).

If you have a PUL, don’t assume you have an ectopic pregnancy or will have a miscarriage. It usually means that the embryo is too small to see. Your doctor will schedule additional scans to see if it appears later. 7

Because threatened miscarriage isn’t a single health condition, doctors don’t “diagnose” it the way they do with other pregnancy complications, like gestational diabetes or preeclampsia. Threatened miscarriage is a way of characterizing the state of a pregnancy—it just indicates that something’s raised a red flag that merits further testing.

That said, if your doctor thinks you have a threatened miscarriage, they’ll likely perform a combination of tests to assess your situation, including: 8

• A pelvic exam: This allows your doctor to check if your cervix is open or closed and evaluate the amount of bleeding you have.
• An ultrasound: This shows the location and progress of your pregnancy, and it can show if there’s a fetal heartbeat. If your pregnancy is too new to visualize a heartbeat, your doctor will schedule a follow-up scan. You may also have a transvaginal ultrasound if you’re in the very early stages of your pregnancy, which provides a clearer picture than an abdominal ultrasound. 9
• Blood tests: If it’s too early to see anything on an ultrasound, your provider may order blood tests to check your levels of human chorionic gonadotropin (hCG), the pregnancy hormone. These levels should rise over time. A leveling of hCG could indicate a miscarriage.

The process of identifying and treating a threatened miscarriage involves ruling out the scarier causes we mentioned above to ensure that your health isn’t in danger and determine whether your pregnancy is still viable.

The first and most important step if you have bleeding and cramping during early pregnancy is to see your doctor.

They may recommend any of a wide variety of treatment options—and might also recommend that you get plenty of rest and avoid having sex during your pregnancy (at least until your bleeding resolves). As mentioned, physical activity and sex don’t usually cause miscarriages, but getting extra rest is never a bad thing when your body’s under stress. 1 8

Depending on what your doctor discovers when they conduct their tests, they might recommend other treatment options. Be prepared for follow-up appointments and further ultrasounds to monitor the progression of your pregnancy.

How to cope if you have a threatened miscarriage

While having a threatened miscarriage isn’t always as dire as it sounds, that doesn’t mean it’s not emotionally challenging. Here’s how to cope:

Get support

Ask your doctor as many questions as you need to settle your anxiety, and reach out to your support network—your family, friends, or partner. If you’re feeling isolated, you can also get in touch with a support group (either in person or online) to connect with other people who’ve been through this.

Rest and practice self-care

Be gentle with yourself. You don’t need to pretend that everything’s fine, but get plenty of rest and eat well.

If you need some time by yourself to process, that’s OK. However, it can be easy to overthink and let your anxieties get the better of you, so don’t take that too far; it’s also a good idea to keep at least a little busy. Make time for activities like walking, journaling, or anything else that helps you put your mind at ease.

Don’t blame yourself

It’s common to feel guilty when dealing with a threatened miscarriage, and you may find yourself fretting about what you should or shouldn’t have done. Remember—the health of your pregnancy is (at least to an extent) out of your control, and luck plays a big factor, so don’t blame yourself.

Unfortunately, there’s often no way to prevent a threatened miscarriage. Your doctor can give you tailored advice for managing your symptoms, but the best thing to do is follow the general lifestyle recommendations for having a healthy pregnancy, such as: 10

• Maintaining a healthy weight
• Eating a balanced pregnancy diet
• Staying active
• Avoiding smoking and alcohol

Remember, activities like working, exercising, and sex do not cause miscarriage. Don’t try to hold yourself back from living your life while you’re pregnant.

“Threatened miscarriage” are words that no parent-to-be ever wants to hear, but as scary as they are, keep in mind that many women who have threatened miscarriages go on to have healthy pregnancies.

Rather than sinking into self-destructive thought patterns, be proactive and speak to your doctor straight away. They’ll be able to make a proper assessment and put your mind at rest. You never have to deal with a threatened miscarriage alone.