Hearing that a pregnancy has ended is hard, and a lot of information arrives at once. Here we explain what matters in the first days: where the pregnancy is now, how certain the diagnosis is, which options you have, and how to keep genetic testing possible if you want it.
If you are bleeding and it is heavy, or you also have severe tummy pain, any shoulder pain, or feel faint or dizzy, call 999. For a fever or other worries, contact your early pregnancy unit or call NHS 111.
Start here
Being told at a scan that a pregnancy has stopped developing can feel unreal, especially if there was no bleeding or pain beforehand. It is fine to ask whoever scanned you to explain things again, to write them down, or to call you once the news has sunk in.
Once a miscarriage is confirmed, NICE guidance makes waiting for 7 to 14 days the usual first approach, unless your risk of heavy bleeding is raised, you have signs of infection or there is another reason to act sooner. If waiting does not feel right, you can ask for tablets or a procedure instead. Either way, there is often time to think, talk things over and gather information before choosing.
Three questions shape almost everything that follows: is the pregnancy still inside your womb, how certain is the diagnosis, and how would you prefer the miscarriage to be managed?
Question one
This decides which genetic tests are still possible. One kind needs a blood sample taken while pregnancy tissue remains in the womb; the other needs the tissue itself once it has come away.
Usually the case after a missed miscarriage found on a scan. A blood test can analyse placental DNA circulating in your bloodstream while placental tissue remains, ideally before any tablets or procedure. Tissue can also be tested later if it is collected correctly. See testing before a miscarriage completes.
Once tissue has left the womb, placental DNA in the blood falls, so a blood test becomes less reliable. The tissue itself may still be testable if it was kept fresh and without preservative. Ask your unit whether anything was kept, and read about pregnancy tissue testing.
Bleeding does not always mean everything has passed. A scan shows whether pregnancy tissue remains, so mention testing when it is arranged. Our which test page compares the options.
Question two
NICE, which sets guidance for the NHS in England, says no single scan can guarantee a 100% accurate diagnosis: there is a small chance it is wrong, especially very early in pregnancy. On an internal (transvaginal) scan it uses the embryo's length from head to bottom (the crown-rump length) or, if no embryo is seen, the average width of the pregnancy sac.
| What the internal scan shows | What NICE says should happen before miscarriage is confirmed |
|---|---|
| Embryo under 7 mm, no heartbeat seen | Another scan no sooner than 7 days later; more than one may be needed |
| Embryo 7 mm or more, no heartbeat seen | Review by a second specialist, another scan no sooner than 7 days later, or both |
| Sac under 25 mm, no embryo seen | Another scan no sooner than 7 days later; more than one may be needed |
| Sac measuring 25 mm or more, with no embryo | Review by a second specialist, another scan no sooner than 7 days later, or both |
| Scan done only through the tummy (abdominal) | Measurements noted, and another scan no sooner than 14 days later |
NICE is clear that waiting for the next scan has no harmful effect on the pregnancy. It also says your period dates on their own should not be used to judge whether a heartbeat should already show.
If you are told the miscarriage is complete, but the pregnancy was never seen inside the womb on an earlier scan, NICE advises follow-up with hormone (hCG) blood tests or further scans, because a pregnancy outside the womb (an ectopic pregnancy) has to be ruled out.
Unsure what your scan showed? Ask for the measurements and whether a second person reviewed the images. See no heartbeat on a scan and an empty pregnancy sac. If you would like a further scan with us, see how we can help.
Question three
Before 14 weeks, the NHS usually offers a choice, depending on your symptoms and how many weeks pregnant you are; from 14 weeks, your care team will discuss different options. Each route affects which genetic tests remain possible, so it helps to think about testing first.
Known as expectant management, and NICE's first option for 7 to 14 days unless your risk of heavy bleeding is raised (for example, later in the first trimester), a condition that makes bleeding more dangerous, signs of infection, or a previous traumatic pregnancy experience. NICE says most people need no further treatment, though a missed miscarriage can take longer (see the timings below). If bleeding has not started by then, or it carries on, you should be offered a repeat scan.
Known as medical management. For a missed miscarriage, the NICE regimen is a 200 mg mifepristone tablet swallowed first, followed 48 hours later by 800 micrograms of misoprostol, with pain relief and anti-sickness medicine as needed. If there is still no bleeding 48 hours after the misoprostol, call your unit.
Known as surgical management. Where it is suitable, NICE says you should be offered a choice of manual vacuum aspiration (gentle suction under local anaesthetic in a clinic) or a procedure in an operating theatre under general anaesthetic. Going home the same day is often possible.
Timings
The first three figures come from UK studies of groups of people. They cannot predict what will happen to you.
Genetic testing
Testing is optional, and not testing is just as valid a choice. About half of early miscarriages are caused by a chromosome change, usually one that happened by chance, but a test does not always find a cause.
Mention it before tablets or a procedure are arranged. NHS testing of pregnancy tissue is generally offered after three or more miscarriages, or when a single loss has features pointing to a chromosome condition.
It works best while tissue is still in the womb, ideally with a scan just beforehand; once tissue has passed, the chance of a result falls over the following hours and days. It is not part of routine NHS care, so it is usually arranged privately, and a genetic counsellor can explain what is available.
Ask the unit or laboratory how to collect, store and deliver tissue. Do not add any preservative yourself; tissue for chromosome testing is normally kept fresh in a sterile pot.
Questions to ask
Keep these on your phone or on paper. You do not need to ask them all at once, and you can ring back later with more.
Was my scan internal, what were the measurements, and has a second specialist reviewed the images?
Will I have a repeat scan, and when?
Which ways of managing the miscarriage are open to me, and is there a deadline for deciding?
What is your 24-hour contact number? NICE says you should be given one.
Could the pregnancy be tested for chromosome changes, and do I qualify on the NHS?
If tissue passes at home, how should I collect and store it, and where do I take it? If I have a procedure, can some be sent fresh to a genetics laboratory?
Is my blood group rhesus negative, and if so, do I need an anti-D injection?
Can I have copies of my scan reports and any results?
What emotional support is available here, for me and for my partner?
Safety
Whichever option you choose, know the signs that need help straight away. The first three follow NHS advice for anyone who is pregnant and bleeding.
Support
There is no right way to feel. People describe numbness, grief and sometimes relief that the uncertainty is over, often on the same day. Partners grieve too. Physical recovery may take days or weeks; the emotional side can take longer.
Many people search for something they did wrong. About half of early miscarriages happen because of a chromosome change that arose by chance, usually while both parents' own chromosomes are normal. A chance change like this is not caused by anything either of you did, and our page why did I miscarry? looks at common worries one by one.
At home, the NHS suggests resting if you need to, taking paracetamol for pain, and avoiding sex until your symptoms have gone, because of the risk of infection. Bleeding or spotting can last for up to 2 weeks.
Ask your GP or early pregnancy unit about counselling; partners can get support too. Miscarriage UK's helpline is 0303 003 6464, and Tommy's midwives are on 0800 0147 800. If you live in England, you can request a free, optional baby loss certificate for a pregnancy that ended before 24 weeks; it is not a legal document.
Next steps
Your NHS early pregnancy unit is the first place to turn for scans, treatment and urgent advice, free of charge. It can also tell you whether you qualify for NHS genetic testing.
If you do not meet the NHS criteria, or you would like a blood-based test before treatment, chromosome testing after miscarriage can be arranged privately. Whoever arranges it, us included, it is worth asking which method is used, what it can and cannot detect, how often it gives no result, and who will explain the findings to you.
A genetic counsellor can help you decide whether to test at all, and which test fits your situation. Ours see people by video, so you can talk it through from home.
For another look at a scan before treatment, you can ask your NHS unit to repeat it, or book a repeat or second-opinion scan with us. Either way, your early pregnancy unit can stay involved.
How we can help
Whatever you decide, your NHS care carries on. If you would like time with a genetic counsellor or a further scan before choosing treatment, these are the appointments most relevant now. You can book without a referral, or call us if you are not sure which fits. London Miscarriage Clinic is part of London Pregnancy Clinic, so booking opens on the London Pregnancy Clinic website.
Online, 30 minutes
A video appointment with one of our registered genetic counsellors, ideally before any tablets or procedure. Talk through whether to test at all, whether a blood or tissue test suits where you are now, and how tissue would be collected. Nothing is arranged unless you want it. A 60-minute appointment suits a more complex history.
6–9 weeks
If you have been told to wait for another scan, or would like a further look before deciding on treatment, one of our fetal medicine specialists checks where the pregnancy is, how it measures and whether a heartbeat can be seen. A repeat scan should be at least 7 days after the first. Booked as our viability scan, with a written report you can share with your unit.
From around 10 weeks
An independent scan with Dr Fred Ushakov, who forms his own view before comparing it with your earlier reports, and gives you a written report by the end of the day. Helpful if the findings were unclear or you want more certainty before treatment. Your own care team still plans any treatment.
After your first period
A gentle ultrasound and review, usually after your first period, to check that the womb has returned to normal and no pregnancy tissue remains, with time to talk to our gynaecology team and midwives about the future. It is a recovery check, not a scan to diagnose a miscarriage.
There is a small chance, especially very early in pregnancy, which is why NICE guidance builds in safeguards. Below set sizes, another scan at least a week later is needed before miscarriage is confirmed; above them, a second opinion or a repeat scan is still advised. Asking for another scan before treatment is reasonable, and NICE says waiting for one does not harm the pregnancy.
If you are well, not bleeding heavily and have no signs of infection, you do not usually have to decide on the day of the scan. NICE's usual first approach is to wait 7 to 14 days, and your unit will tell you if there is a medical reason to act sooner.
No. Many tests find a chromosome change, but many do not, and a normal chromosome result does not rule out other causes. Some people value an answer even when it does not change their future care; others decide not to test. Our page on understanding results explains each type of answer.
Not usually. NHS testing of pregnancy tissue is generally offered after three or more miscarriages, or after a single miscarriage with features suggesting a chromosome condition. If your miscarriage happened from 14 weeks, ask your team which tests they recommend. Blood-based testing after miscarriage is not part of routine NHS care. Either kind can be arranged privately if you would like it sooner.
Possibly. Contact your early pregnancy unit as soon as you can; tissue for chromosome testing needs to be fresh and free of preservative. What is collected at home is sometimes mostly blood clot or your own tissue, so a result is not guaranteed. In a Danish study covering all ways of managing a miscarriage, about 1 in 3 women either could not collect pregnancy tissue or collected tissue that was probably their own.
Not necessarily. Placental DNA keeps entering your blood while placental tissue is in the womb. Once the tissue has passed, levels fall: in a Danish study they dropped noticeably after about 12 hours, and more tests gave no result over the next 3 days. A scan just before the sample shows whether tissue remains.
Even when well timed, it gives a screening-type result rather than a diagnosis. Across eight studies, it picked up about 78 in every 100 chromosome changes that tissue testing found, roughly 4 in 5. Our blood test page explains its strengths and limits.
Yes. You can book a scan or a genetic counselling appointment with us directly, without a GP referral, while your NHS early pregnancy unit stays involved. If you can, bring or send copies of earlier scan reports and results so we can see what has already been found.
This page gives general information about miscarriage, its management and genetic testing. It cannot take account of your own history or scan findings, and it does not replace individual advice from the doctors, nurses and midwives looking after you. If you have heavy bleeding, severe pain or a fever, or you feel faint, get in touch with your early pregnancy unit or call NHS 111, and call 999 in an emergency.
Contact
The figures and clinical statements on this page are drawn from the sources below. Guidance evolves — always discuss your individual circumstances with a clinician.
