Thinking about first-trimester loss during your subsequent pregnancy is hard. (And let’s be honest … it’s also hard NOT to think about it).

Even though it’s uncomfortable – OK, just plain painful – to think about losing this baby, it’s still important you know the warning signs of first-trimester loss. This will help you get the medical care you deserve to either rule out a loss or give you the support you need if the worst should happen again.

sad woman - what you need to know about first-trimester loss

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As you read, keep in mind that there are many causes for the kinds of symptoms listed below, and not all mean that you will experience a loss. Accurately reporting your symptoms and getting prompt care from a medical provider is important in getting the correct answer as to what is going on.

Below are the different kinds of losses you could experience in the first 12 weeks, as well as what you might feel or experience during them:

Miscarriage

A miscarriage is simply the spontaneous loss of a baby in pregnancy from conception up to 20 weeks that is not caused by the rare conditions listed below. Please note that the physical experience of that loss may be very different between an early miscarriage and a late one.

What you need to know:

Here are some symptoms that may indicate that you could be experiencing a miscarriage[1]“Miscarriage,” American Pregnancy Association, October 15, 2019, https://americanpregnancy.org/pregnancy-complications/miscarriage/., and should be seen by your provider:

  • Cramping. This is the bane of many pregnant women because some cramping is normal as your uterus stretches. However, if your cramping becomes more frequent, is intolerable, or you can time it like contractions, let your provider know. Go to the emergency room if your cramping is unbearable.
  • Bleeding. This can range from dark brown spotting to period-like bleeding. Any bleeding that is more than soaking a pad an hour warrants immediate medical attention, but any bleeding should prompt a call to your medical provider[2]“Bleeding and Spotting From the Vagina During Pregnancy,” March of Dimes, April 2014, https://www.marchofdimes.org/complications/bleeding-and-spotting-from-the-vagina-during-pregnancy.aspx. .
  • Cessation of pregnancy symptoms. Again, this is a hard symptom to quantify because pregnancy symptoms naturally wax and wane in a healthy pregnancy. However, experiencing a complete cessation of symptoms may indicate that your hCG has dropped. If several days have passed, and your symptoms have not come back, call your nurse.
  • Passing tissue or clots. This could be tissue that doesn’t really look like anything in particular or it can be your formed baby in a gestational sac[3]“Blighted Ovum,” American Pregnancy Association, August 2015, https://americanpregnancy.org/pregnancy-complications/blighted-ovum/.. You may want to save the tissue for testing. Call your doctor if you are passing tissue and ask how they’d like you to proceed.
  • Back pain that is worse or different than normal.

Signs your doctor may note that could indicate miscarriage:

  • Slow-rising or dropping hCG levels. Having pregnancy hormones that are not doubling appropriately is often associated with loss, and dropping hormones almost always means loss. Because other kinds of loss besides miscarriage are possible, such as an ectopic pregnancy, it is important to follow your doctor’s orders about tracking your hCG and going in for an ultrasound if they request it[4]“Human Chorionic Gonadotropic (hCG) Levels and Miscarriage: What You Need to Know,” Rachel Nall, MSN, CRNA, reviewed by Holly Ernst, PA-C, Healthline Parenthood, February 26, 2019, … Continue reading.
  • Abnormal ultrasound results. Your ultrasound tech may not see what one would expect for your baby’s gestational age. This could be no gestational sac, no fetal pole, your baby measuring small for what they think you are based on your last menstrual cycle, or slow fetal heart rate. In an ectopic pregnancy, the tech may find a mass, free fluid, or a baby implanted in the wrong spot. They also may see your uterus with thickened lining, but no other signs of pregnancy. In a blighted ovum, the baby never develops within the gestational sac. While ultrasounds are tortuous, especially when you suspect something is wrong, be sure to wait to hear your doctor’s opinion on your imaging. Your dates may be off or more testing might need to be done to have a definitive answer.
  • Dilated cervix indicated by ultrasound or pelvic exam.
  • Certain abnormal results of chromosomal tests.

Signs that you need emergent care[5]“When to Call Your Doctor During Pregnancy,” What to Expect editors, What to Expect, November 21, 2019, https://www.whattoexpect.com/pregnancy/when-to-call-a-doctor/.:

  • Soaking a pad at a rate of one (or more) per hour.
  • Fever or chills indicating infection.
  • Bad smelling discharge with signs of miscarriage.
  • Pain that is incredibly sharp, one-sided, or otherwise unbearable.
  • Vomiting with pain.
  • Signs of ruptured ectopic pregnancy (see below).

Chemical Pregnancy

A chemical pregnancy is a form of miscarriage in which the pregnancy can be documented by blood work – you are in fact pregnant – but nothing yet is visible on ultrasound because you are so early[6]“Miscarriage,” American Pregnancy Association, October 15, 2019, https://americanpregnancy.org/pregnancy-complications/miscarriage/.. This term usually applies to pregnancies before the fifth week.

What you need to know:

You might have a chemical pregnancy if you have a negative pregnancy test after you’ve already had a positive one. You might also begin bleeding shortly after your positive test. However, it is important to have bloodwork checked by your provider. There are many causes of bleeding, and not all indicate a loss.

Missed Miscarriage

A missed miscarriage is one where your body has not recognized that your baby is no longer living[7]“Missed Miscarriage,” Miscarriage Association, https://www.miscarriageassociation.org.uk/information/miscarriage/missed-miscarriage/..

What you need to know:

Since your body is not giving you any symptoms that your pregnancy is no longer viable, this kind of loss is found incidentally through clinical testing (either bloodwork or ultrasound). This kind of loss is often shocking. Talk to your doctor about your options concerning testing and how to begin the miscarriage process.

Ectopic Pregnancy

Ectopic means “out of place,” so instead of settling in in your uterus, the fertilized egg implants somewhere else. Most ectopics are located within the fallopian tube, however, they can also be located at either end of your fallopian tube, your cervix, on a previous uterine scar, or in your abdomen. In extremely rare cases (less than one percent of ectopics), you can have one healthy pregnancy in your womb and an ectopic pregnancy elsewhere at the same time[8]“What You Should Know About Heterotopic Pregnancy,” Daniel M. Avery, MD, Marion D. Reed, MD, and William L. Lenahan, MD, OBG Manag. 2009 October;21(10):30-34, … Continue reading.

What you need to know:

Ectopic pregnancies are not viable, even when a baby with a heartbeat is found on ultrasound. Doctors are unable to transplant a pregnancy from an ectopic location into your uterus. In an ectopic, your body is not designed to support the blood supply your baby needs anywhere other than your uterus, so your baby may not have formed properly. However, the growing baby and placenta put incredible stress on your fragile tissues, putting you at risk for rupture and internal bleeding. A ruptured ectopic pregnancy is a life-threatening emergency.

If you are pregnant or have had a missed period, and have any of these signs or symptoms of an ectopic, talk to your provider right away[9]“Symptoms of Ectopic Pregnancy,” The Ectopic Pregnancy Trust, https://ectopic.org.uk/patients/symptoms-and-diagnosis/.:

  • Cramping that increases in severity.
  • Abdominal pain on one side.
  • Slow-rising hCG or hCG levels that go up and down.
  • Bleeding or brown watery discharge. (This does not always indicate ectopic, but report any bleeding to your practitioner just in case.)
  • Abdominal discomfort when straining (such as coughing or sneezing), peeing, or pooping.
  • Continued symptoms of pregnancy, even after heavy bleeding.

Get emergent care or call 911 at the following signs, which could indicate your fallopian tube has ruptured[10]“Ectopic Pregnancy,” Stephen Metz, MD, and Jeff Disney, MD, FAEM, eMedicine Health, February 2019, https://www.emedicinehealth.com/ectopic_pregnancy/article_em.htm.:

  • Sharp, unbearable pain in your abdomen. This can be in one location in your abdomen or diffuse throughout.
  • Vomiting with pain.
  • Dizziness or fainting.
  • Shoulder tip pain.
  • Looking pale.
  • Signs of shock.

Remember, early detection of an ectopic is best, so talk to your doctor if you have concerns you may have an ectopic pregnancy.

Molar Pregnancy

A molar pregnancy is a rare condition in which the cells that create the placenta form abnormally. This is due to incorrect fertilization at conception. Sometimes your baby still forms (a partial molar pregnancy) and sometimes no fetus can be found (a complete molar pregnancy[11]“Molar Pregnancy,” March of Dimes, October 2017, https://www.marchofdimes.org/complications/molar-pregnancy.aspx.).

What you need to know:

Molar pregnancies must be taken care of by a doctor as they have serious consequences, including the chance of a rare form of cancer. You may need to be followed by your doctor, and delay any further pregnancies, for up to a year.

Symptoms of a molar pregnancy include[12]“Molar Pregnancy,” Mayo Clinic Staff, Mayo Clinic, December 14, 2017, https://www.mayoclinic.org/diseases-conditions/molar-pregnancy/symptoms-causes/syc-20375175.:

  • Bleeding in the first trimester.
  • Severe nausea and bleeding.
  • Pelvic pressure or pain.
  • Vaginal passage of cysts that look similar to grapes.

Your doctor may notice clinical signs of molar pregnancy[13]“Molar Pregnancy,” Mayo Clinic Staff, Mayo Clinic, December 14, 2017, https://www.mayoclinic.org/diseases-conditions/molar-pregnancy/symptoms-causes/syc-20375175. such as:

  • Anemia.
  • Ovarian cysts.
  • A uterus that is too large for gestational age.
  • Thyroid issues.
  • High blood pressure.

Thinking you may be experiencing a first-trimester loss is never easy. But it can be especially difficult when this pregnancy comes after a loss.

Talk with your provider early in the pregnancy to discuss your particular risks for loss, as well as any signs or symptoms they want you to call about. If you are going to your doctor’s after experiencing concerning symptoms, bring a support person with you. They can offer emotional support as you wait to hear the news. And they can also help you remember any of your doctor’s orders or recommendations.

As you walk through this pregnancy after loss – if your symptoms are concerning to you, always bring them up to your provider. Sometimes, early detection that something is going wrong is critical.

And if it turns out nothing is wrong – it’s so much better to have that assurance than to constantly wonder.

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