Missed miscarriage – NHS updates, info & most-asked questions

The experience of missed miscarriage – and managing treatment via the NHS – is increasingly on my mind as we navigate Baby Loss Awareness Week (9-15 October 2024). 

More friends, friends of friends and women I speak to have been through it. And given the complexity of a missed miscarriage – plus the fact that your first experience may be in-clinic during a routine scan – demand for authoritative, go-to support and guidance is high.

What is a missed miscarriage?

Missed miscarriage, also known as a silent or delayed miscarriage, happens when a pregnancy ends without any of the common physical signs or symptoms, like cramping or bleeding. 

For some women, there may be a more subtle feeling that something isn’t quite right – your breasts may stop feeling tender, for example or your nausea may suddenly subside. But in many cases, there may be no indication at all that anything is wrong. 

This type of loss is typically discovered during routine scans – so it can come as an acute shock, and be emotionally overwhelming. 

My own experience of miscarriage is very different. My losses came with symptoms, and for the most part happened at home – I went into hospital to move the process forward (as clunky as that sounds) – meaning that my body broke the news to me. With a missed miscarriage, this will come from a clinician.

What do we mean by ‘missed’?

While some miscarriages start with physical symptoms, such as bleeding and/or pain, some don’t come with any signs at all. 

The Miscarriage Association missed miscarriage info page notes that your pregnancy hormones may remain elevated for a while after the pregnancy has ended, which is why many women still feel pregnant or get a positive on a pregnancy test, even at the point of diagnosis.

How common is missed miscarriage?

While miscarriages are common, affecting one in four pregnancies during the first trimester, missed miscarriages occur in just 1-5% of pregnancies. And it’s this crucial difference – a quiet loss, without any symptoms – which can make this rarer type of miscarriage very difficult to navigate. 

In today’s feature, we’re breaking down the current NHS guidance, information from The Miscarriage Association and updates leading into 2025, providing insights into how you – and your clinicians – will likely manage a missed miscarriage.  

We’ll also share links to lived experiences from the community, from personal stories and coping strategies to forums, groups and social accounts who may be able to help. 

Have we missed anything out? We’re so keen to help and learn from the TRB community. If you have time and capacity, drop us a DM – we read every single one, and what you have to say shapes the support we love to provide.

The NHS top line

It’s worth noting that at the time of writing, the NHS miscarriage information page is due for review in March 2025. So we’ll refresh the information here in due course. 

A missed (or delayed) miscarriage will usually be diagnosed initially during a routine ultrasound scan, as part of your antenatal care – this could be at your 12 week scan or the 20 week anomaly scan. 

The scan picture may show the pregnancy sac, but that your baby has no heartbeat, or that it is measuring too small for the date of your pregnancy. In this case, your clinician may be able to tell you roughly when the baby died. 

In other cases of missed miscarriage, the ultrasound won’t show a clear sac – or it may show as empty. This is because the pregnancy ended at the embryo stage much earlier on and has been reabsorbed by the body. This is often referred to as ‘early embryo loss’ (or ‘blighted ovum’, which is more old-fashioned). 

Miscarriage can be a very stressful time, and this may be made more difficult by entering a ‘waiting period’, where your doctor or care team will advise having another scan maybe a week later, to check for any growth and a detectable heartbeat. 

I really recommend picking up with The Miscarriage Association during this time – they run a Live Chat function, helpline and email inbox and publish so many real life experiences and stories, meeting you where you’re at with information, coping strategies and support. Lauren’s story: missed miscarriage might be a helpful starting point. 

After your missed miscarriage is diagnosed, you may be referred to a hospital’s: 

• early pregnancy unit, for tests
• maternity unit (if you’re more than 18 weeks pregnant)

For some women experiencing miscarriage, the body may naturally pass the pregnancy (the NHS uses the term pregnancy tissue here) from the uterus. With a missed miscarriage, this process is delayed, and it’s likely that some or all of the pregnancy tissue will still be in your uterus – your clinician may explain this as ‘retained’.

Treatment options

For a missed miscarriage, the primary concern will be how to help your body pass the pregnancy – either naturally, or with clinical intervention. The decision-making process can be really tough here, so let’s break it down clearly. 

Your options will usually be: 

• expectant management – (sometimes referred to as ‘conservative management’) you’ll wait for your body to recognise the miscarriage, and pass the pregnancy tissue naturally 
• medical management – with prescribed medicine (oral, vaginal or a combination – increasingly the preferred option is MifeMiso, combining the medications mifepristone and misoprostol) to cause the tissue to pass out of your uterus
• surgical management – the tissue will be surgically removed

Expectant management notes

With expectant management – waiting for the miscarriage to happen naturally – you’ll still be monitored by the hospital over a period of 7-14 days before intervention may be recommended. 

The NHS often recommends this for miscarriage treatment in general, especially in the first 8-9 weeks of pregnancy or in women with incomplete miscarriage (where some but not all of the pregnancy tissue has passed). 

It has a 75-80% success rate on average in cases of incomplete miscarriage – the success rates are lower with missed miscarriage. National guidance from NICE also recommends natural management as the first treatment option to consider. These recommendations are due for review, however, and the information and video put together by Tommy’s can really help to make sense of things.

How long can it take for a missed miscarriage to pass?

With expectant management, it’s impossible to know when your body will naturally begin the miscarriage process. This can make things very difficult emotionally – many women have the feeling of wanting to ‘move on’ – so keep talking through your options with your doctor and hospital team. 

Expectant (natural), medical or surgical – whatever you decide, the NHS say that risk of complications is very small for these options. However, it’s important that you feel informed, creating a treatment path which feels best for you. 

Discuss all of them with the doctor in charge of your care, asking about the risks and benefits of each. And, if you need more support or a few days to make your decision, I recommend contacting the Miscarriage Association to talk things through. 

Their animation Helping people through might also be a helpful watch – it touches on missed miscarriage and one couple’s experience. I’d also suggest connecting with Dr Marie Prince, for specialist, compassionate therapy support from an experienced Consultant Clinical Psychologist. 

As the amazing team at The Miscarriage Association reiterate, you don’t need to go through this alone. And really, I couldn’t have. From the specialist charities covered here today, to super-supportive social accounts like The Worst Girl Gang Ever and The Miscarriage Doula, there are so many safe spaces to make your go-to. 

When you’re ready, read this next – What happens after a miscarriage?