Miscarriage Symptoms: When to Seek Emergency Care

Miscarriage (spontaneous abortion) = pregnancy loss <20 weeks. Affects 10–20% of known pregnancies. Prompt evaluation reduces complications.

Warning Signs (Seek Care Immediately)

• Vaginal bleeding: light spotting → heavy with clots/tissue
• Cramping: lower abdomen/back, rhythmic or constant
• Passage of tissue: grayish-pink material
• Sudden loss of pregnancy symptoms (nausea, breast tenderness)
• Fever >38°C (100.4°F), chills — suggests septic miscarriage
• Dizziness, fainting, shoulder tip pain — suggests ectopic pregnancy (emergency)

What "One Week Late + Clots/Tissue" Means

If bleeding with clots/tissue occurs ~1 week after expected menses in a woman with positive pregnancy test or risk factors, this is highly suggestive of completed miscarriage. Still requires confirmation (ultrasound, β-hCG trend) to rule out retained products or ectopic.

Clinical Workup

• Quantitative β-hCG (serial 48-hr trends)
• Transvaginal ultrasound (viability, retained tissue)
• CBC, type & screen if bleeding heavy
• Rh typing → Rhogam if Rh-negative

Management Options

• Expectant: Wait for spontaneous passage (80% complete in 2–6 wks).
• Medical: Misoprostol 800 mcg vaginal/buccal — expedites passage.
• Surgical: D&C if heavy bleeding, infection, or patient preference.

Aftercare

Abstain from vaginal insertion ×2 weeks. Follow-up β-hCG to zero. Conceive after 1 normal cycle if desired. Grief support referral.